Sellin Jonathan N, Raskin Jeffrey S, Staggers Kristen A, Brayton Alison, Briceño Valentina, Moreno Amee J, Jea Andrew
1Division of Pediatric Neurosurgery, Texas Children's Hospital, Department of Neurosurgery, Baylor College of Medicine, Houston, Texas; and.
2Section of Pediatric Neurosurgery, Riley Hospital for Children, Department of Neurosurgery, Indiana University School of Medicine, Goodman Campbell Brain and Spine, Indianapolis, Indiana.
J Neurosurg Pediatr. 2018 Feb;21(2):190-196. doi: 10.3171/2017.7.PEDS17240. Epub 2017 Nov 17.
Thoracic and lumbar cortical bone trajectory pedicle screws have been described in adult spine surgery. They have likewise been described in pediatric CT-based morphometric studies; however, clinical experience in the pediatric age group is limited. The authors here describe the use of cortical bone trajectory pedicle screws in posterior instrumented spinal fusions from the upper thoracic to the lumbar spine in 12 children. This dedicated study represents the initial use of cortical screws in pediatric spine surgery. The authors retrospectively reviewed the demographics and procedural data of patients who had undergone posterior instrumented fusion using thoracic, lumbar, and sacral cortical screws in children for the following indications: spondylolysis and/or spondylolisthesis (5 patients), unstable thoracolumbar spine trauma (3 patients), scoliosis (2 patients), and tumor (2 patients). Twelve pediatric patients, ranging in age from 11 to 18 years (mean 15.4 years), underwent posterior instrumented fusion. Seventy-six cortical bone trajectory pedicle screws were placed. There were 33 thoracic screws and 43 lumbar screws. Patients underwent surgery between April 29, 2015, and February 1, 2016. Seven (70%) of 10 patients with available imaging achieved a solid fusion, as assessed by CT. Mean follow-up time was 16.8 months (range 13-22 months). There were no intraoperative complications directly related to the cortical bone trajectory screws. One patient required hardware revision for caudal instrumentation failure and screw-head fracture at 3 months after surgery. Mean surgical time was 277 minutes (range 120-542 minutes). Nine of the 12 patients received either a 12- or 24-mg dose of recombinant human bone morphogenic protein 2. Average estimated blood loss was 283 ml (range 25-1100 ml). In our preliminary experience, the cortical bone trajectory pedicle screw technique seems to be a reasonable alternative to the traditional trajectory pedicle screw placement in children. Cortical screws seem to offer satisfactory clinical and radiographic outcomes, with a low complication profile.
胸腰椎皮质骨轨迹椎弓根螺钉已应用于成人脊柱手术。在基于儿科CT的形态学研究中也有相关描述；然而，儿科年龄组的临床经验有限。本文作者描述了12例儿童从上胸椎至腰椎后路器械辅助脊柱融合术中皮质骨轨迹椎弓根螺钉的应用。这项专门研究代表了皮质骨螺钉在儿科脊柱手术中的首次应用。作者回顾性分析了因以下适应症在儿童中使用胸、腰和骶皮质骨螺钉进行后路器械辅助融合术患者的人口统计学和手术数据：椎弓根峡部裂和/或椎体滑脱（5例）、不稳定胸腰椎脊柱创伤（3例）、脊柱侧弯（2例）和肿瘤（2例）。12例年龄在11至18岁（平均15.4岁）的儿科患者接受了后路器械辅助融合术。共置入76枚皮质骨轨迹椎弓根螺钉，其中胸段螺钉33枚，腰段螺钉43枚。患者于2015年4月29日至2016年2月1日接受手术。10例有可用影像学资料的患者中，7例（70%）经CT评估实现了牢固融合。平均随访时间为16.8个月（范围13 - 22个月）。没有与皮质骨轨迹螺钉直接相关的术中并发症。1例患者术后3个月因尾端器械失败和螺钉头骨折需要进行内固定翻修。平均手术时间为277分钟（范围120 - 542分钟）。12例患者中有9例接受了12毫克或24毫克剂量的重组人骨形态发生蛋白2。平均估计失血量为283毫升（范围25 - 1100毫升）。根据我们的初步经验，皮质骨轨迹椎弓根螺钉技术似乎是儿童传统轨迹椎弓根螺钉置入术的合理替代方法。皮质骨螺钉似乎能提供令人满意的临床和影像学结果，且并发症发生率较低。
