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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Figures

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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.

  • 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 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).

  • View in gallery

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

References

1

Abumi KPanjabi MMKramer KMDuranceau JOxland TCrisco JJ: Biomechanical evaluation of lumbar spinal stability after graded facetectomies. Spine (Phila Pa 1976) 15:114211471990

2

De Boeck MDe Smedt EPotvliege R: Computed tomography in the evaluation of a congenital absent lumbar pedicle. Skeletal Radiol 8:1971991982

3

Dietemann JLMacedo RMedjek LBabin EWackenheim A: [Bilateral pedicular cleft in a patient with neurofibromatosis (author's transl).]. Ann Radiol (Paris) 24:6656671981. (Fr)

4

Johansen JGMcCarty DJHaughton VM: Retrosomatic clefts: computed tomographic appearance. Radiology 148:4474481983

5

Kaito TKato YSakaura HYamamoto KHosono N: Congenital absence of a lumbar pedicle presenting with contralateral lumbar radiculopathy. J Spinal Disord Tech 18:2032052005

6

Lauten GJWehunt WD: Computed tomography in absent cervical pedicle. AJNR Am J Neuroradiol 1:2012031980

7

Lederman HMKaufman RA: Congenital absence and hypoplasia of pedicles in the thoracic spine. Skeletal Radiol 15:2192231986

8

Lorenz MPatwardhan AVanderby R Jr: Load-bearing characteristics of lumbar facets in normal and surgically altered spinal segments. Spine (Phila Pa 1976) 8:1221301983

9

Macleod SHendry GM: Congenital absence of a lumbar pedicle. A case report and a review of the literature. Pediatr Radiol 12:2072101982

10

Mizutani MYamamuro TShikata J: Congenital absence of a lumbar pedicle. Spine (Phila Pa 1976) 14:8908911989

11

Morin MEPalacios E: The aplastic hypoplastic lumbar pedicle. Am J Roentgenol Radium Ther Nucl Med 122:6396421974

12

Oh YMEun JP: Congenital absence of a cervical spine pedicle: report of two cases and review of the literature. J Korean Neurosurg Soc 44:3893912008

13

Polly DW JrMason DE: Congenital absence of a lumbar pedicle presenting as back pain in children. J Pediatr Orthop 11:2142191991

14

Sener RN: Sacral pedicle agenesis. Comput Med Imaging Graph 21:3613631997

15

Sener RNRipeckyj GTJinkins JR: Agenesis of a lumbar pedicle: MR demonstration. Neuroradiology 33:4641991

16

Sharma MLangrana NARodriguez J: Role of ligaments and facets in lumbar spinal stability. Spine (Phila Pa 1976) 20:8879001995

17

Sheehan JKaptain GSheehan JJane J Sr: Congenital absence of a cervical pedicle: report of two cases and review of the literature. Neurosurgery 47:143914422000

18

Soleimanpour MGregg MLParaliticci R: Bilateral retrosomatic clefts at multiple lumbar levels. AJNR Am J Neuroradiol 16:161616171995

19

Tiyaworabun SBeeko DBock WJ: Congenital absence of a pedicle in the cervical spine. Acta Neurochir (Wien) 61:3033171982

20

Wiener MDMartinez SForsberg DA: Congenital absence of a cervical spine pedicle: clinical and radiologic findings. AJR Am J Roentgenol 155:103710411990

21

Wortzman GSteinhardt MI: Congenitally absent lumbar pedicle: a reappraisal. Radiology 152:7137181984

22

Yousefzadeh DKEl-Khoury GYLupetin AR: Congenital aplastic-hypoplastic lumbar pedicle in infants and young children. Skeletal Radiol 7:2592651982

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