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Use of Pedicle Screws in Spinal Surgery in Young Children

Pedicle screws are commonly used in spinal surgery to connect the vertebrae, the bones of the spine. Their use in adults and older children as been studied, but in young children, who have smaller diameter spines and need smaller screws, there isn't much research or understanding or possible risks. The authors of this study wanted to determine the feasibility and accuracy of pedicle screw placement in children who were younger than eight years old. This age was chosen because the spinal canal generally reaches adults size between the ages of six and eight years.

Researchers looked at the files of 16 children, ranging in age from two years, three months to seven years, eleven months. These 16 children had undergone computed tomography scans of their spines after having pedicle screws inserted during surgery. Altogether, the 16 patients had 88 screws, 30 in the thoracic spine (mid to upper back) and 58 in the lumbar spine (lower back).

As the researchers examined the CT scans, they were looking to see the position of the screws and if there were any complications after surgery from the screws. They found that none of the 16 patients had any complications from the screws and none required a revision surgery to correct the screw placement. There were breaches but no patient had any problems or symptoms.

In assessing accuracy of screw placement, the overall accuracy was 93.2 percent, while the breach rate was 6.8 percent or six screws. The breaches were more common in the thoracic spine (four screws) than the lumbar spine (two screws).

The authors concluded that this study showed that younger children can benefit from the use of pedicle screws in correcting spinal deformities, however, based on findings from another study by Senaran and colleagues, smaller screws would likely be a better choice for children between five years and eight years old.

References: Ashish Ranade, MD, et al. Feasibility and Accuracy of Pedicle Screws in Children Younger Than Eight Years of Age. In Spine. Dec 15, 2009. Vol. 34. No. 26. Pp. 2907 to 2911.

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