1;The Growing Spine;2 1.1;Dedication;4 1.2;Foreword I;6 1.3;Foreword II;8 1.4;Foreword III;10 1.5;Preface;11 1.6;Contents;13 1.7;Contributors;17 1.8;Section I:General ;24 1.8.1;1: Embryology and Anatomy:Spine/Spinal Cord ;25 1.8.1.1;1.1 Introduction;25 1.8.1.2;1.2 Early Development;25 1.8.1.3;1.3 Somite Formationand Differentiation;27 1.8.1.4;1.4 Central Nervous SystemDevelopment;29 1.8.1.5;1.5 Peripheral Extension of the CNS;Formation of the PeripheralNervous System31 1.8.1.6;1.6 Vertebral Ossifi cation;31 1.8.1.7;1.7 Conclusion;34 1.8.1.8;References;34 1.8.2;2:Normal Growth of the Spine and Thorax;35 1.8.2.1;2.1 Growth Holds the Basics;35 1.8.2.2;2.2 Biometric Measurements;36 1.8.2.2.1;2.2.1 Standing Height;36 1.8.2.2.2;2.2.2 Sitting Height;37 1.8.2.2.3;2.2.3 Subischial Limb Length;37 1.8.2.2.4;2.2.4 Arm Span;37 1.8.2.2.5;2.2.5 Weight;39 1.8.2.2.6;2.2.6 The Multiplying Coeffi cient;41 1.8.2.3;2.3 Chronology;41 1.8.2.3.1;2.3.1 Intrauterine Development;41 1.8.2.3.2;2.3.2 From Birth to 5 Years;41 1.8.2.3.3;2.3.3 From 5 Years to Beginningof Puberty;42 1.8.2.3.4;2.3.4 Puberty: A Turning Point;42 1.8.2.3.5;2.3.5 Secondary Sexual Characteristics;44 1.8.2.3.6;2.3.6 Pubertal Diagram and Peak HeightVelocity (Figs. 2.7-2.10);45 1.8.2.4;2.4 Estimation of Skeletal Maturity;46 1.8.2.5;2.5 The Concept of Risser sign isMisleading (Figs. 2.13, 2.14);47 1.8.2.6;2.6 Growth of the Trunk;49 1.8.2.6.1;2.6.1 Growth in the Spinal Column;49 1.8.2.6.2;2.6.2 Cervical Spine;50 1.8.2.6.3;2.6.3 T1-S1 Segment (Figs. 2.15, 2.16);50 1.8.2.6.4;2.6.4 Thoracic Spine T1-T12(Figs. 2.19, 2.20);50 1.8.2.6.5;2.6.5 Lumbar Spine (L1-L5);50 1.8.2.6.6;2.6.6 The Thoracic Growth is the FourthDimension of the Spine [20];51 1.8.2.6.7;2.6.7 Scoliosis and Puberty;55 1.8.2.6.8;2.6.8 The Scoliotic Risk;57 1.8.2.6.9;2.6.9 Growth in the Paralytic Child;58 1.8.2.7;2.7 Lessons Learned from Growth;58 1.8.2.8;2.8 The Growing Spine:from the Normal to Abnormal;59 1.8.2.8.1;2.8.1 The Pathologic Spine is Dominatedby the Crankshaft Phenomenon;59 1.8.2.8.2;2.8.2 Growth DisturbancesAfter Spinal Arthrodesis;59 1.8.2.9;2.9 From Birth to 5 Years of Age,the Spine-Rib-Lung Complex;60 1.8.2.9.1;2.9.1 A Thorough Pediatric Evaluationis a Priority;60 1.8.2.9.2;2.9.2 From Five to Puberty,a Quiescent Period;61 1.8.2.9.3;2.9.3 What we Know, Where we are,and Which Way to Follow?;62 1.8.2.10;References;62 1.8.3;3:Biomechanics in the Growing Spine;65 1.8.3.1;3.1 Background;65 1.8.3.2;3.2 Biomechanical Considerationsfor Instrumenting the GrowingSpine;66 1.8.3.3;3.3 Conclusions;68 1.8.3.4;References;69 1.8.4;4:Genetics;71 1.8.4.1;4.1 Basic Genetics;71 1.8.4.2;4.2 The Chromosome and DNA;71 1.8.4.3;4.3 Genetic Polymorphismsand Their Relation to Diseases;73 1.8.4.4;4.4 Types of Disease;74 1.8.4.5;4.5 Disease Gene Mapping;74 1.8.4.6;4.6 Linkage Analysison Familial Subjects;75 1.8.4.7;4.7 Case-Control Association Studieson Population-Based Subjects;76 1.8.4.8;4.8 Genetic Mutationsto Spinal Abnormalities;77 1.8.4.9;4.9 Genetics of Idiopathic Scoliosis;78 1.8.4.10;References;80 1.9;Section II:Evaluation of the Growing Child;82 1.9.1;5:Clinical Examination;83 1.9.1.1;5.1 Introduction;83 1.9.1.2;5.2 Medical History;83 1.9.1.2.1;5.2.1 Birth History;83 1.9.1.2.2;5.2.2 Family History;83 1.9.1.2.3;5.2.3 Spinal Deformity History;83 1.9.1.3;5.3 Physical Examination;84 1.9.1.3.1;5.3.1 Overall Health and Reviewof Systems;84 1.9.1.3.2;5.3.2 Neurological Status;84 1.9.1.3.3;5.3.3 Mental Status;84 1.9.1.3.4;5.3.4 Pain Status;84 1.9.1.3.5;5.3.5 Musculoskeletal Statusand Examination of the Thorax;84 1.9.1.4;5.4 Diagnostic Laboratory Testing;86 1.9.1.5;5.5 Diagnostic Imaging;86 1.9.1.5.1;5.5.1 Radiographs;86 1.9.1.5.2;5.5.2 Magnetic Resonance Imaging (MRI);86 1.9.1.5.3;5.5.3 Computed Tomography (CT);87 1.9.1.6;5.6 Developing a ComprehensiveTreatment Plan;87 1.9.1.6.1;5.6.1 Postoperative Examination;87 1.9.1.7;References;87 1.9.2;6:Comorbidities Associatedwith Early Onset Scoliosis;88 1.9.2.1;6.1 Introduction;88 1.9.2.2;6.2 Orga