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Perthes' disease and posterior lumbosacral union
Insights
Children with Perthes' disease experience delayed bone development and often exhibit delayed fusion of lumbosacral elements. This fusion failure, including spina bifida occulta, improves with age, normalizing by adulthood.
Area of Science:
- Orthopedics
- Pediatric Bone Development
- Spinal Fusion
Background:
- Perthes' disease is characterized by delayed bone development and smaller stature in affected children.
- Previous studies noted normal somatosensory evoked potentials (SEP) in Perthes' disease.
- Lumbosacral fusion patterns in children with Perthes' disease require further investigation.
Purpose of the Study:
- To investigate the incidence and progression of lumbosacral fusion abnormalities in children with Perthes' disease.
- To determine the relationship between age and the resolution of posterior lumbar and sacral fusion defects.
Main Methods:
- Retrospective examination of 54 patients with active or healed Perthes' disease.
- Assessment of posterior lumbar and/or sacral fusion status based on age.
- Comparison of fusion rates across different age groups.
Main Results:
- All children under 8 years with Perthes' disease showed failure of posterior lumbar and/or sacral fusion.
- Fusion rates increased with age; by 14 years, 50% had normal fusion and 50% had spina bifida occulta.
- By age 16, fusion incidence approached that of the general population, indicating delayed but eventual fusion.
Conclusions:
- Delayed fusion of lumbosacral elements is a significant finding in Perthes' disease.
- These fusion abnormalities tend to resolve with growth and age.
- Perthes' disease impacts not only femoral head development but also spinal fusion patterns.
Abstract:
Delayed bone development is common in Perthes' disease, and affected children are usually smaller than normal. Somatosensory evoked potentials (SEP) studied in 25 cases of Perthes' disease were normal. Fifty-four patients with active or healed Perthes' disease were examined. Every child aged less than 8 years showed failure of posterior lumbar and/or sacral fusion. With growth, fusion increased so that at age 14 years 50% had a normal fusion and 50% had spina bifida occulta. At age greater than 16 years, the incidence was similar to that in the general population. In Perthes' disease, growth in fusion of the lumbosacral elements is delayed.