Pathophysiology of the pediatric patient

Embryologic failure of normal development leads to predictable patterns of malformation in the pediatric spine. Intuitively, co-developing organ systems may be adversely affected as well. These most commonly are the genitourinary and cardiovascular systems. Failure of neural tube closure early in embryogenesis results in a variety of central nervous system defects requiring surgical correction. This leads to lifelong disability affecting not only the nervous system but musculoskeletal and genitourinary systems as well. The most prevalent type of scoliosis is acquired idiopathic, which affects mostly otherwise healthy adolescents. These patients present with a cosmetic defect requiring correction to prevent progressive compromise of underlying lung function and the potential for worsening restrictive lung disease from associated thoracic cage derangement. Recent evidence suggests that certain unidentified systemic mediators may produce a generalized skeletal muscle dysfunction in adolescents with thoracolumbar scoliosis. Several unique aspects of the immature, pediatric spine affect its reaction to trauma differently than in the adult spine. Zach’s back was out of whack It swerved and curved like a railroad track Where most backs lie in a line so straight Zach’s formed an S or a figure eight. Zach discovered when he lay face down That his back was used by the kids in town Who played Parcheesi and their games Or tattooed maps on his vertebrae. There was nothing else With quite the knack As that Singularly Interesting Back of Zach’s Rivian Bell