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Published on: May 31, 2017
Pedicle screws in 1- and 2-year-old children: technique, complications, and effect on further growth
1Department of Orthopedics and Traumatology, Center for Spinal Surgery, Klinikum Karlsbad-Langensteinbach, Karlsbad, Germany. michael.ruf@kkl.srh.de
Insights
Pedicle screw fixation is safe and effective for treating pediatric spinal disorders in 1- and 2-year-olds. This technique does not negatively impact vertebral growth, offering secure spinal anchorage.
Area of Science:
- Pediatric Orthopedics
- Spinal Surgery
- Biomedical Engineering
Background:
- Limited research exists on pedicle screw use in very young children (1-2 years old).
- Existing studies focus on adults and older children, leaving a knowledge gap for infant spinal fixation.
Purpose of the Study:
- To assess the safety and effectiveness of pedicle screw fixation in 1- and 2-year-old children.
- To evaluate the impact of pedicle screw insertion on vertebral growth in this age group.
Main Methods:
- Retrospective review of 19 operations involving 91 pedicle screws in 16 pediatric patients (1-2 years old).
- Analysis of complications (short- and long-term, direct and general).
- Radiographic evaluation of vertebral growth in three cases with over 6 years of follow-up.
Main Results:
- Low complication rates: 2 short-term (fracture, infection) and 3 long-term (screw breakage, connection failure).
- Three screws misplaced without neurological deficits.
- No adverse effects on vertebral growth observed in long-term follow-up.
Conclusions:
- Pedicle screw fixation is a safe and effective method for pediatric spinal disorders in very young children.
- Transpedicular screw fixation provides secure anchorage for short-segment spinal instrumentation in this population.
- The procedure does not impede further vertebral development.
Study Design:
A retrospective study of 19 consecutive cases (1991-2001) where 91 thoracic and lumbar pedicle screws were used in the treatment of various pediatric spinal disorders in 1- and 2-year-old children.
Objectives:
To determine the effectiveness and safety of pedicle screw fixation in very young children and to evaluate the effect of pedicle screw insertion on further growth of the vertebra.
Summary Of Background Data:
Although many studies exist about the use of pedicle screws and its advantages in spinal fixation in adults and older children, no study has been published about the use of pedicle screws in 1- and 2-year-old children.
Methods:
A retrospective review of 19 consecutive operations in 16 patients with insertion of 91 pedicle screws for various spinal disorders in 1- and 2-year-old children was performed. The technique of screw insertion was described. Complications were divided into those directly related to screw placement and general complications and short- and long-term complications. In three cases with more than 6 years follow-up, the effect of pedicle screw insertion on further growth was evaluated by radiographic measurements.
Results:
Short-term complications occurred in two patients (one pedicle fracture, one infection) and long-term complications in three patients (one screw breakage, two failures of screw connection). Three of 91 screws were misplaced without any neurologic symptoms. Measurements of the vertebral growth in long-term follow-up did not show any adverse effect related to pedicle screw insertion.
Conclusion:
The results suggest that pedicle screw fixation can be performed safely in 1- and 2-year-old children without negative effects on vertebral growth. In various pediatric spinal disorders, transpedicular screw fixation is the only procedure that provides a secure anchorage in short-segment instrumentation.
