Blakemore Laurel, Schwend Richard, Akbarnia Behrooz A, Dumas Megan, Schmidt John
Department of Orthopaedics and Rehabilitation, University of Florida, Gainesville, FL.
Children's Mercy Hospital, Pediatric Orthopaedic Surgery, Kansas City, MO.
J Pediatr Orthop. 2018 Mar;38(3):181-184. doi: 10.1097/BPO.0000000000000781.
Gross anatomic study of osteological specimens.
To evaluate the age of closure for the neurocentral synchondrosis (NCS) in all 3 regions of the spine in children aged 1 to 18 years old.
The ossification of the human vertebra begins from a vertebral body ossification center and a pair of neural ossification centers located within the centrum called the NCS. These bipolar cartilaginous centers of growth contribute to the growth of the vertebral body, spinal canal, and posterior elements of the spine. The closure of the synchondroses is dependent upon location of the vertebra and previous studies range from 2 to 16 years of age. Although animal and cadaveric studies have been performed regarding NCS growth and early instrumentation's effect on its development, the effects of NCS growth disturbances are still not completely understood.
The vertebrae of 32 children (1 to 18 y old) from the Hamann-Todd Osteological collection were analyzed (no 2 or 9 y old specimens available). Vertebrae studied ranged from C1 to L5. A total of 768 vertebral specimens were photographed on a background grid to allow for measurement calibration. Measurements of the right and left NCS, pedicle width at the NCS, and spinal canal area were taken using Scandium image-analysis software (Olympus Soft Imaging Solutions, Germany). The percentage of the growth plate still open was found by dividing the NCS by the pedicle width and multiplying by 100. Data were analyzed with JMP 11 software (SAS Institute Inc., Cary, NC).
The NCS was 100% open in all 3 regions of the spine in the 1- to 3-year age group. The cervical NCS closed first with completion around 5 years of age. The lumbar NCS was nearly fully closed by age 11. Only the thoracic region remained open through age 17 years. The left and right NCS closed simultaneously as there was no statistical difference between them. In all regions of the spine, the NCS appeared to close sooner in males than in females. Spinal canal area increased with age up to 12 years old in the cervical and thoracic spine but did not significantly change after age 3 in the lumbar spine.
In conclusion, closure of the NCS differed among the cervical, thoracic, and lumbar spine regions. The NCS reached closure in males before females even though females mature faster and reach skeletal maturity sooner than males. However, it is not determined whether the continued open NCS in females to a later age may be a factor in their increased rate of scoliosis.
骨骼标本的大体解剖学研究。
评估1至18岁儿童脊柱所有三个区域神经中央软骨结合（NCS）的闭合年龄。
人类椎体的骨化始于椎体骨化中心和位于椎体中心内的一对神经骨化中心，即NCS。这些双极软骨生长中心有助于椎体、椎管和脊柱后部结构的生长。软骨结合的闭合取决于椎体的位置，先前的研究范围为2至16岁。尽管已经进行了关于NCS生长以及早期器械植入对其发育影响的动物和尸体研究，但NCS生长紊乱的影响仍未完全了解。
分析了来自哈曼 - 托德骨骼收藏的32名儿童（1至18岁）的椎体（无2岁或9岁的标本）。研究的椎体范围从C1到L5。总共768个椎体标本在背景网格上拍照，以便进行测量校准。使用钪图像分析软件（德国奥林巴斯软成像解决方案公司）测量左右NCS、NCS处的椎弓根宽度和椎管面积。通过将NCS除以椎弓根宽度并乘以100来计算生长板仍开放的百分比。数据用JMP 11软件（SAS研究所，北卡罗来纳州卡里）进行分析。
在1至3岁年龄组中，脊柱所有三个区域的NCS均100%开放。颈椎NCS首先闭合，约在5岁时完成。腰椎NCS在11岁时几乎完全闭合。只有胸椎区域在17岁时仍保持开放。左右NCS同时闭合，因为它们之间没有统计学差异。在脊柱的所有区域，NCS在男性中似乎比在女性中闭合得更早。颈椎和胸椎的椎管面积在12岁之前随年龄增加，但腰椎在3岁之后没有显著变化。
总之，NCS在颈椎、胸椎和腰椎区域的闭合情况不同。尽管女性比男性成熟更快且骨骼成熟更早，但NCS在男性中比在女性中更早闭合。然而，女性NCS在较晚年龄仍持续开放是否可能是其脊柱侧弯发生率增加的一个因素尚未确定。
