A review of the pathomechanism of forward slippage in pediatric spondylolysis: The Tokushima theory of growth plate slippage

Koichi Sairyo; Akihiro Nagamachi; Tetsuya Matsuura; Kosaku Higashino; Toshinori Sakai; Naoto Suzue; Daisuke Hamada; Yoichiro Takata; Tomohiro Goto; Toshihiko Nishisho; Yuichiro Goda; Takahiko Tsutsui; Ichiro Tonogai; Ryo Miyagi; Mitsunobu Abe; Masatoshi Morimoto; Kazuaki Mineta; Tetsuya Kimura; Akihiro Nitta; Tadahiro Higuchi; Shingo Hama; Subash C. Jha; Rui Takahashi; Shoji Fukuta

doi:10.2152/jmi.62.11

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A review of the pathomechanism of forward slippage in pediatric spondylolysis: The Tokushima theory of growth plate slippage

Koichi Sairyo, Akihiro Nagamachi, Tetsuya Matsuura, Kosaku Higashino, Toshinori Sakai, Naoto Suzue, Daisuke Hamada, Yoichiro Takata, Tomohiro Goto, Toshihiko Nishisho, Yuichiro Goda, Takahiko Tsutsui, Ichiro Tonogai, Ryo Miyagi, Mitsunobu Abe, Masatoshi Morimoto, Kazuaki Mineta, Tetsuya Kimura, Akihiro Nitta, Tadahiro Higuchi, Shingo Hama, Subash C. Jha, Rui Takahashi, Shoji Fukuta

Author information

Koichi Sairyo
Department of Orthopedics, Tokushima University
Akihiro Nagamachi
Department of Orthopedics, Tokushima University
Tetsuya Matsuura
Department of Orthopedics, Tokushima University
Kosaku Higashino
Department of Orthopedics, Tokushima University
Toshinori Sakai
Department of Orthopedics, Tokushima University
Naoto Suzue
Department of Orthopedics, Tokushima University
Daisuke Hamada
Department of Orthopedics, Tokushima University
Yoichiro Takata
Department of Orthopedics, Tokushima University
Tomohiro Goto
Department of Orthopedics, Tokushima University
Toshihiko Nishisho
Department of Orthopedics, Tokushima University
Yuichiro Goda
Department of Orthopedics, Tokushima University
Takahiko Tsutsui
Department of Orthopedics, Tokushima University
Ichiro Tonogai
Department of Orthopedics, Tokushima University
Ryo Miyagi
Department of Orthopedics, Tokushima University
Mitsunobu Abe
Department of Orthopedics, Tokushima University
Masatoshi Morimoto
Department of Orthopedics, Tokushima University
Kazuaki Mineta
Department of Orthopedics, Tokushima University
Tetsuya Kimura
Department of Orthopedics, Tokushima University
Akihiro Nitta
Department of Orthopedics, Tokushima University
Tadahiro Higuchi
Department of Orthopedics, Tokushima University
Shingo Hama
Department of Orthopedics, Tokushima University
Subash C. Jha
Department of Orthopedics, Tokushima University
Rui Takahashi
Department of Orthopedics, Tokushima University
Shoji Fukuta
Department of Orthopedics, Tokushima University

Keywords: Spondylolysis, spondylolisthesis, growth plate, adolescents, children

JOURNAL FREE ACCESS

2015 Volume 62 Issue 1.2 Pages 11-18

DOI https://doi.org/10.2152/jmi.62.11

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Abstract

Spondylolysis is a stress fracture of the pars interarticularis, which in some cases progresses to spondylolisthesis (forward slippage of the vertebral body). This slip progression is prevalent in children and occurs very rarely after spinal maturation. The pathomechanism and predilection for children remains controversial despite considerable clinical and basic research into the disorder over the last three decades. Here we review the pathomechanism of spondylolytic spondylolisthesis in children and adolescents, and specifically the Tokushima theory of growth plate slippage developed from our extensive research findings. Clinically, we have observed the slippage site near the growth plate on MRI; then, using fresh cadaveric spines, we found the weakest link against forward shear loading was the growth plate. We subsequently developed an immature rat model showing forward slippage after growth plate injury. Moreover, finite element analysis of the pediatric spine clearly showed increased mechanical stress at the growth plate in the spondylolytic pediatric spine model compared with the intact pediatric spine. Thus, spondylolysis progresses to spondylolisthesis (forward slippage) in children and adolescents with the growth plate as the site of the slippage. Repetitive mechanical loading on to the growth plate may serve to separate the growth plate and subsequently progress to spondylolisthesis. J. Med. Invest. 62: 11-18, February, 2015

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