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The spine plays an essential biomechanical role, and disruptions to the structure of the vertebral column can have profound clinical consequences. The structure of the spine is patterned early in embryonic development with the formation of transient segmental structures called somites. Developmental studies have helped to identify the genetic pathways regulating this process and the mutations that...
The vertebral column is composed of alternating vertebrae and intervertebral (IV) discs supported by robust spinal ligaments and muscles. All of these elements, bony, cartilaginous, ligamentous, and muscular, are essential to the structural integrity of the spine. The spine serves three vital functions: protecting the spinal cord and spinal nerves, transmitting the weight of the body, and providing...
Axial skeletal development is part of the complex, inclusive process of axial or midline development. It involves the interaction of many tissues including the embryonic notochord, neural tube, somite compartments, intersomitic angiopotent cells, and neural crest cells. These tissues give rise to the axial skeleton, intervertebral discs, spinal cord, trunk musculature and dorsal dermis, intervertebral...
Scoliosis is really a physical finding, a lateral curvature of the spine. There are a number of potential causes, not all of which are related to a primary spinal deformity. For instance, if a patient has one leg longer than another, they will display a curved spine; otherwise their trunk would leave the pelvis at an angle, causing the individual to always look like they are leaning to one side. In...
In the most commonly occurring form of scoliosis in clinical practice, adolescent idiopathic scoliosis, there is no apparent malformation of the vertebrae. The process of segmentation that gives rise to somites, followed by resegmentation giving rise to vertebrae, and the subsequent formation of the vertebrae all appear normal. Abnormal formation of the vertebrae, for example, in some of the skeletal...
Puerto Rico is the smallest of the four Greater Antilles islands, which also includes Cuba, Hispaniola, and Jamaica, localized in the Caribbean Sea. Puerto Rico was discovered in 1493 by Christopher Columbus and became a Spanish territory until the Spanish–American War of 1898, when it became a US territory. The particular history of our country provides us with a specific social, cultural, and ethnic...
Vertebral development occurs through a sequential and highly orchestrated series of interconnected events involving fibroblast growth factor (FGF), WNT, Notch, and transforming growth factor beta (TGF-β) receptor signaling pathways. Perturbations in these pathways can result in the development of both congenital (curvature of the spine due to an abnormality in vertebral formation) and idiopathic scoliosis...
Idiopathic scoliosis is a fixed structural lateral curve of the spine of ≥10° affecting 2–3% of children making it the most common spinal abnormality in children. Clinically, it is characterized by a subtle, pain-free onset of bony deformity in otherwise normal individuals (see Fig. 8.1). Although the female-to-male ratio is approximately 1:1 for minor curves, the proportion of females increases dramatically...
“Scoliosis” is derived from the Greek word meaning “crooked” and was used for the first time by Galen (AD 131–201) to describe an “S-shaped” or “C-shaped” spinal deformity (Fig. 9.1). Although defined as a lateral curvature as visualized by plane radiography, the deformity is actually three-dimensional and involves changes in the frontal, sagittal, and transverse planes of the spinal column. Patients...
Developmental and genetic studies of the spine, genetic linkage to vertebral anomalies, and family-based association studies have led to advances in understanding the genetic causes of idiopathic and congenital scoliosis. Chapters in this volume have been prepared by research leaders who have been working to identify the genetic and developmental causes of idiopathic and congenital scoliosis. Technological...
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