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 Paul Randall Harrington Neuro-Spine Program, Division of Pediatric Neurosurgery, Texas Children's Hospital; and Department of Neurosurgery, Baylor College of Medicine, Houston, Texas
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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.

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Contributor Notes

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.

  • 1

    Abumi K, , Panjabi MM, , Kramer KM, , Duranceau J, , Oxland T, & Crisco JJ: Biomechanical evaluation of lumbar spinal stability after graded facetectomies. Spine (Phila Pa 1976) 15:11421147, 1990

    • Search Google Scholar
    • Export Citation
  • 2

    De Boeck M, , De Smedt E, & Potvliege R: Computed tomography in the evaluation of a congenital absent lumbar pedicle. Skeletal Radiol 8:197199, 1982

    • Search Google Scholar
    • Export Citation
  • 3

    Dietemann JL, , Macedo R, , Medjek L, , Babin E, & Wackenheim A: [Bilateral pedicular cleft in a patient with neurofibromatosis (author's transl).]. Ann Radiol (Paris) 24:665667, 1981. (Fr)

    • Search Google Scholar
    • Export Citation
  • 4

    Johansen JG, , McCarty DJ, & Haughton VM: Retrosomatic clefts: computed tomographic appearance. Radiology 148:447448, 1983

  • 5

    Kaito T, , Kato Y, , Sakaura H, , Yamamoto K, & Hosono N: Congenital absence of a lumbar pedicle presenting with contralateral lumbar radiculopathy. J Spinal Disord Tech 18:203205, 2005

    • Search Google Scholar
    • Export Citation
  • 6

    Lauten GJ, & Wehunt WD: Computed tomography in absent cervical pedicle. AJNR Am J Neuroradiol 1:201203, 1980

  • 7

    Lederman HM, & Kaufman RA: Congenital absence and hypoplasia of pedicles in the thoracic spine. Skeletal Radiol 15:219223, 1986

  • 8

    Lorenz M, , Patwardhan A, & Vanderby R Jr: Load-bearing characteristics of lumbar facets in normal and surgically altered spinal segments. Spine (Phila Pa 1976) 8:122130, 1983

    • Search Google Scholar
    • Export Citation
  • 9

    Macleod S, & Hendry GM: Congenital absence of a lumbar pedicle. A case report and a review of the literature. Pediatr Radiol 12:207210, 1982

    • Search Google Scholar
    • Export Citation
  • 10

    Mizutani M, , Yamamuro T, & Shikata J: Congenital absence of a lumbar pedicle. Spine (Phila Pa 1976) 14:890891, 1989

  • 11

    Morin ME, & Palacios E: The aplastic hypoplastic lumbar pedicle. Am J Roentgenol Radium Ther Nucl Med 122:639642, 1974

  • 12

    Oh YM, & Eun JP: Congenital absence of a cervical spine pedicle: report of two cases and review of the literature. J Korean Neurosurg Soc 44:389391, 2008

    • Search Google Scholar
    • Export Citation
  • 13

    Polly DW Jr, & Mason DE: Congenital absence of a lumbar pedicle presenting as back pain in children. J Pediatr Orthop 11:214219, 1991

  • 14

    Sener RN: Sacral pedicle agenesis. Comput Med Imaging Graph 21:361363, 1997

  • 15

    Sener RN, , Ripeckyj GT, & Jinkins JR: Agenesis of a lumbar pedicle: MR demonstration. Neuroradiology 33:464, 1991

  • 16

    Sharma M, , Langrana NA, & Rodriguez J: Role of ligaments and facets in lumbar spinal stability. Spine (Phila Pa 1976) 20:887900, 1995

  • 17

    Sheehan J, , Kaptain G, , Sheehan J, & Jane J Sr: Congenital absence of a cervical pedicle: report of two cases and review of the literature. Neurosurgery 47:14391442, 2000

    • Search Google Scholar
    • Export Citation
  • 18

    Soleimanpour M, , Gregg ML, & Paraliticci R: Bilateral retrosomatic clefts at multiple lumbar levels. AJNR Am J Neuroradiol 16:16161617, 1995

    • Search Google Scholar
    • Export Citation
  • 19

    Tiyaworabun S, , Beeko D, & Bock WJ: Congenital absence of a pedicle in the cervical spine. Acta Neurochir (Wien) 61:303317, 1982

  • 20

    Wiener MD, , Martinez S, & Forsberg DA: Congenital absence of a cervical spine pedicle: clinical and radiologic findings. AJR Am J Roentgenol 155:10371041, 1990

    • Search Google Scholar
    • Export Citation
  • 21

    Wortzman G, & Steinhardt MI: Congenitally absent lumbar pedicle: a reappraisal. Radiology 152:713718, 1984

  • 22

    Yousefzadeh DK, , El-Khoury GY, & Lupetin AR: Congenital aplastic-hypoplastic lumbar pedicle in infants and young children. Skeletal Radiol 7:259265, 1982

    • Search Google Scholar
    • Export Citation

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