Congenital hypoplasia or aplasia of the lumbosacral pedicle as an unusual cause of spondylolisthesis in the pediatric age group

Case report

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The authors describe rare cases of congenital hypoplasia of the L-5 pedicles and the congenital absence of the left S-1 pedicle in 2 young girls, respectively, including the presentation, diagnosis, and treatment. Moreover, they review the literature on this clinical entity. The patients presented with intractable chronic low-back pain. Plain radiographs and 2D CT scanning revealed the presence of the aforementioned anomalies. Degenerative changes to adjacent level and contralateral facet joints were thought to be the result of overload and instability and seemed to have led to spondylolisthesis, micromotion at L-5 and S-1, and subsequent low-back pain. The pediatric patients were treated with posterior instrumented fusion with good functional outcomes at a minimum 3-month follow-up. To the best of the authors' knowledge, these are the first reports of intractable low-back pain and spondylolisthesis accompanied by hypoplastic-aplastic pedicles at the lumbosacral junction in children.

Article Information

Address correspondence to: Andrew Jea, M.D., Texas Children's Hospital, 6621 Fannin Street, CCC 1230.01, 12th Floor, Houston, Texas 77030. email: ahjea@texaschildrens.org.

Please include this information when citing this paper: published online April 19, 2013; DOI: 10.3171/2013.3.PEDS12579.

© AANS, except where prohibited by US copyright law.

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    Case 1. Contiguous axial scans at the lumbosacral junction were obtained at 5-mm intervals without contrast. The digital information was then reprocessed in the coronal plane. This 2D sagittal reconstruction of spinal CT scans demonstrates congenitally hypoplastic bilateral L-5 pedicles and articulating processes. The inferior articulating process of L-4 interacts directly with the superior articulating process of S-1 to form an abnormal facet joint. Left: Sagittal CT obtained prior to a previous untethering procedure. Right: Sagittal CT obtained at the most recent presentation.

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    Case 1. Standing plain radiograph of the lumbosacral spine. This neutral weight-bearing radiograph shows Meyerding Grade I spondylolisthesis at L5–S1.

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    Case 1. Postoperative lateral (left) and anteroposterior (right) lumbosacral spine radiographs obtained 16 months after surgery, showing the L4–S1 posterior instrumented fusion.

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    Case 2. Standing plain radiograph of the lumbosacral spine. This neutral weight-bearing radiograph shows Meyerding Grade I spondylolisthesis at L5–S1.

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    Case 2. Contiguous axial scans at the lumbosacral junction were obtained at 5-mm intervals without contrast. The digital information was then reprocessed in the coronal plane. This 2D coronal reconstruction of spinal CT scans demonstrates a congenitally absent left S-1 pedicle (arrow).

  • View in gallery

    Case 2. Contiguous axial scans at the lumbosacral junction were obtained at 5-mm intervals without contrast. The digital information was then reprocessed in the coronal plane. This 2D sagittal reconstruction of spinal CT scans demonstrates a severely degenerated hyperplastic contralateral L5–S1 facet joint including a fractured superior articulating process of S-1 (arrow).

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    Case 2. Postoperative lateral (left) and anteroposterior (right) lumbosacral spine radiographs obtained 3 months after surgery, demonstrating the L5–S2 posterior instrumented fusion.

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