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A Spine Robotic-Assisted Navigation System for Pedicle Screw Placement
Published on: May 11, 2020
Safety and accuracy of pedicle screws and constructs placed in infantile and juvenile patients
Katsumi Harimaya1, Lawrence G Lenke, Jochen P Son-Hing
1Graduate School of Medical Sciences, Fukuoka, Japan.
Insights
Pedicle screws are safe for young children undergoing spinal deformity surgery, with a low complication rate and high accuracy. This study confirms their efficacy in pediatric patients under 10 years old.
Area of Science:
- Pediatric Orthopedics
- Spinal Surgery
- Biomedical Engineering
Background:
- Limited data exists on pedicle screw use in pediatric spinal deformities for patients under 10 years old.
- Adult and adolescent spinal deformity literature is extensive, but pediatric data is scarce.
- This study addresses the safety and efficacy gap in young pediatric patients.
Purpose of the Study:
- To assess the safety of pedicle screws in patients younger than 10 years.
- To evaluate the accuracy of pedicle screw placement.
- To determine short-term and long-term complication rates (>2 years) associated with pedicle screws in pediatric spinal deformity.
Main Methods:
- Retrospective review of 88 patients with pediatric spinal deformities.
- Analysis of 948 pedicle screws placed at a single institution.
- Radiographic review by two independent spinal surgeons to assess screw accuracy.
Main Results:
- Over 99% of pedicle screws were accurately placed, with a malposition rate of 0.84%.
- No intraoperative or short-term complications were directly linked to pedicle screw insertion.
- Long-term complications related to pedicle screws occurred in 2.3% of patients (0.4% of screws).
Conclusions:
- Pedicle screw placement in infantile and juvenile spinal deformity patients (<10 years) is safe.
- A low rate of intraoperative, short-term, and long-term complications associated with pedicle screws was observed.
- High accuracy (>99%) and minimal long-term complications support the use of pedicle screws in this pediatric population.
Study Design:
Retrospective review.
Objective:
To determine the safety of pedicle screws placed in infantile and juvenile patients younger than 10 years of age, and to evaluate the accuracy and the incidence of short and long-term (>2-year follow-up) complications for the screws and construct utilized.
Summary Of Background Data:
Although much has been written regarding the use of pedicle screws for the treatment of adult and adolescent spinal deformities, few studies have examined complication rates with regard to pedicle screws placed for pediatric spinal deformities in patients younger than 10 years of age.
Methods:
Eighty-eight patients treated with 948 pedicle screws placed for a variety of pediatric spinal deformities were performed at a single institution. We evaluated the accuracy of pedicle screw placement via radiographic review by two spinal surgeons not involved in the surgical treatment.
Results:
The average age at surgery was 6.8 year (range, 1 + 11 to 9 + 11 year). Five hundred ninety-four pedicle screws were placed in the thoracic spine and 354 screws in the lumbar spine. Three screws (0.32%) violated the lateral wall of the pedicle, two screws (0.21%) violated the inferior wall, and three screws (0.32%) were suspected of medial wall violation for a total of eight screws (0.84%) malpositioned. Although short-term complications occurred in nine patients (10.2%) (four-wound infection, two-foot drop, two-respiratory problems, first-sixth cranial nerve palsy), there were no insertion or short-term complications specifically related to the use of pedicle screws. Long-term complications occurred in nine patients (10.2%) (three-deformity progression, four-growing rod breakage), whereas two patients required revision surgery because of pullout and prominence of proximal thoracic pedicle screws (n = 4) placed in growing rod constructs (2.3% of patients, 0.4% of screws).
Conclusion:
There were no intraoperative or short-term pedicle screw insertion-related complications and a very low long-term complication rate (2.3% of patients, 0.4% of screws) specifically related to the use of pedicle screws in infantile and juvenile spinal deformity patients. More than 99% of screws were accurately placed.
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