Seo Hyoung Yeon, Yim Ji Hyeon, Heo Jung Pil, Patil Abhishek S, Na Seung Min, Kim Sung Kyu, Chung Jae Yoon
Department of Orthopaedic Orthopaedic Surgery, Chonnam National University Hospital, Gwangju, Korea.
Department of Orthopaedic Surgery, Gwangju Hyundae Hospital, Gwangju, Korea.
Indian J Orthop. 2013 Nov;47(6):559-64. doi: 10.4103/0019-5413.121577.
Pedicle screws are being used commonly in the treatment of various spinal disorders. However, use of pedicle screws in the pediatric population is not routinely recommended because of the risk of complications. The present study was to evaluate the safety of pedicle screws placed in children aged less than 10 years with spinal deformities and to determine the accuracy and complication (early and late) of pedicle screw placement using the postoperative computed tomography (CT) scans.
Thirty one patients (11 males and 20 females) who underwent 261 pedicle screw fixations (177 in thoracic vertebrae and 84 in lumbar vertebrae) for a variety of pediatric spinal deformities at a single institution were included in the study. The average age of patients was 7 years and 10 months. These patients underwent postoperative CT scan which was assessed by two independent observers (spine surgeons) not involved in the treatment.
Breach rate was 5.4% (14/261 screws) for all pedicles. Of the 177 screws placed in the thoracic spine, 13 (7.3%) had breached the pedicle, that is 92.7% of the screws were accurately placed within pedicles. Seven screws (4%) had breached the medial pedicle wall, 4 screws (2.3%) had breached the lateral pedicle wall and 2 screws (1.1%) had breached the superior or inferior pedicle wall respectively. Of the 84 screws placed in the lumbar spine, 83 (98.8%) screws were accurately placed within the pedicle. Only 1 screw (1.2%) was found to be laterally displaced. In addition, the breach rate was found to be 4.2% (11/261 screws) with respect to the vertebral bodies. No neurological, vascular or visceral complications were encountered.
The accuracy of pedicle screw placement in pedicles and vertebral bodies were 94.6% and 95.8% respectively and there was no complication related to screw placement noted until the last followup. These results suggest that free-hand pedicle screw fixation can be safely used in patients younger than 10 years to treat a variety of spinal disorders.
椎弓根螺钉常用于治疗各种脊柱疾病。然而，由于存在并发症风险，通常不建议在儿童患者中使用椎弓根螺钉。本研究旨在评估在10岁以下脊柱畸形儿童中置入椎弓根螺钉的安全性，并利用术后计算机断层扫描（CT）评估椎弓根螺钉置入的准确性及并发症（早期和晚期）情况。
本研究纳入了在单一机构接受261枚椎弓根螺钉固定术（胸椎177枚，腰椎84枚）以治疗各种儿童脊柱畸形的31例患者（男11例，女20例）。患者的平均年龄为7岁10个月。这些患者术后接受了CT扫描，由两名未参与治疗的独立观察者（脊柱外科医生）进行评估。
所有椎弓根的穿破率为5.4%（14/261枚螺钉）。在置入胸椎的177枚螺钉中，13枚（7.3%）穿破椎弓根，即92.7%的螺钉准确置入椎弓根内。7枚螺钉（4%）穿破椎弓根内侧壁，4枚螺钉（2.3%）穿破椎弓根外侧壁，2枚螺钉（1.1%）分别穿破椎弓根上壁或下壁。在置入腰椎的84枚螺钉中，83枚（98.8%）准确置入椎弓根内。仅1枚螺钉（1.2%）向外移位。此外，相对于椎体的穿破率为4.2%（11/261枚螺钉）。未出现神经、血管或内脏并发症。
椎弓根螺钉在椎弓根和椎体中的置入准确率分别为94.6%和95.8%，直至最后一次随访均未发现与螺钉置入相关的并发症。这些结果表明，徒手椎弓根螺钉固定术可安全用于10岁以下患者治疗各种脊柱疾病。
