Abstract
BACKGROUND CONTEXT
Pedicle screws are widely used in spinal surgeries. Pedicle screw fixation has shown
better clinical effects than other techniques by providing steady fixation from the
posterior arch to the vertebral body. However, there are several concerns about the
impact of pedicle screw instrumentation insertion on vertebral development in young
children, including early closure of the neurocentral cartilage (NCC). The effect
of pedicle screw insertion in an early age on further growth of the upper thoracic
spine is still unclear.
PURPOSE
This study aimed to evaluate the impact of pedicle screw insertion on further growth
of the upper thoracic vertebra and spinal canal.
STUDY DESIGN
A retrospective case study
PATIENT SAMPLE
Twenty-eight patients.
OUTCOME MEASUREMENTS
X-ray and CT parameters including length, height and area of the vertebrae and spinal
canal were manually measured.
METHODS
Twenty-eight patients who underwent pedicle screw fixation (T1-T6) before the age
of 5 years from March 2005 to August 2019 at Peking Union Medical College Hospital
were recruited, and records were retrospectively reviewed. Vertebral body and spinal
canal parameters were measured at instrumented and adjacent noninstrumented levels
and compared using statistical methods.
RESULTS
Ninety-seven segments met the inclusion criteria (average age at instrumentation 44.57
months, range from 23–60 months). Thirty-nine segments had no screws, and 58 had at
least one screw. There was no significant difference between the preoperative and
final follow-up values of the measurement of vertebral body parameters. No significant
difference was observed between the growth rates in levels with or without screws
in pedicle length, vertebral body diameter, or spinal canal parameters.
CONCLUSION
Pedicle screw instrumentation in the upper thoracic spine does not cause a negative
effect on the development of the vertebral body and spinal canal in children younger
than 5 years old.
Keywords
To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to The Spine JournalAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- Posterior correction of adolescent idiopathic scoliosis with high-density pedicle screw-only constructs: 5 years of follow-up.Yonsei Med J. 2020; 61: 323-330
- X-Ray assessment of the effect of pedicle screw on vertebra and spinal canal growth in children before the age of 7 years.Eur Spine J. 2014; 23: 520-529
- Hybrid constructs pedicle screw with apical sublaminar bands versus pedicle screws only for surgical correction of adolescent idiopathic scoliosis.Eur Spine J. 2018; 27: 150-156
- Intraoperative cone beam CT in hybrid operation room for pediatric scoliosis patients: comparison of pedicle screw violation rate at normal and low radiation doses.Spine (Phila Pa 1976. 2022; 47: E507-E513
- Less invasive pediatric spinal deformity surgery: the case for robotic-assisted placement of pedicle screws.HSS J. 2021; 17: 317-325
- Age of closure of the neurocentral cartilage in the thoracic spine.J Pediatr Orthop. 1998; 18: 168-172
- Prospective study of the effect of pedicle screw placement on development of the immature vertebra in an in vivo porcine model.Eur Spine J. 2011; 20: 1892-1898
- The effect of pedicle screw insertion through the neurocentral cartilage on the growth of immature canine vertebra.Orthop Surg. 2009; 1: 137-143
- Evaluation of a more ventral starting point for thoracic pedicle screws: higher maximal insertional arc and more medial and safer screw angulation.J Neurosurg Spine. 2018; 30: 337-343
- Growth patterns of the neurocentral synchondrosis (NCS) in immature cadaveric vertebra.J Pediatr Orthop. 2018; 38: 181-184
- Development of the neurocentral junction as seen on magnetic resonance images.Stud Health Technol Inform. 2002; 91: 229-234
- The effect of pedicle screw placement with or without application of compression across the neurocentral cartilage on the morphology of the spinal canal and pedicle in immature pigs.Spine (Phila Pa 1976). 2005; 30: 1287-1293
- Pedicle screws in 1- and 2-year-old children: technique, complications, and effect on further growth.Spine (Phila Pa 1976). 2002; 27: E460-E466
- Pedicle screw implantation in the thoracic and lumbar spine of 1-4-year-old children: evaluating the safety and accuracy by a computer tomography follow-up.J Spinal Disord Tech. 2013; 26: E46-E52
- The effect of pedicle screw insertion at a young age on pedicle and canal development.Spine (Phila Pa 1976). 2012; 37: 1778-1784
Kahraman S, Karadereler S, Cobanoglu M, Yilar S, Mutlu A, Ulusoy LO, et al. Does pedicle screw fixation under age 5 cause spinal canal narrowing? A CT study with minimum 5 years follow-up. (1432-0932 (Electronic)).
Article info
Publication history
Published online: May 18, 2023
Accepted:
May 2,
2023
Received in revised form:
March 29,
2023
Received:
December 4,
2022
Publication stage
In Press Journal Pre-ProofFootnotes
FDA device/drug status: Not applicable
Author disclosures: This research was funded in part by the National High Level Hospital Clinical Research Funding (2022-PUMCH-D-007 to N.W. Level F, 2022-PUMCH-C-033 to J.Z., Z.W. and N.W Level I), the CAMS Innovation Fund for Medical Sciences (CIFMS, 2021-I2M-1-051 to J.Z. and N.W. Level G, 2021-I2M-1-052 to Z.W. Level E, 2020-I2M-C&T-B-030 to J.Z. Level B) and the Beijing Natural Science Foundation (7222133 to S.W. Level D).
Identification
Copyright
© 2023 Elsevier Inc. All rights reserved.
