Orthopedic Spine Surgeon, Deputy Head Medical University of Bialystok, Dept. of Pediatric Orthopedics Bialystok, Poland
Introduction: The current treatment of spinal deformities are almost impossible without pedicle screws (PS) placement. Many studies confirmed that PS can be inserted by a freehand technique in patients with spinal deformities with a very low frequency of complications. While the technique is well documented in adults, there are not many studies evaluating the safety of screw placement, possible complications in children less than 10 years of age. The present study was to evaluate the safety and accuracy of the PS placement in children aged less than 10 years with spinal deformities and to determine the accuracy and complication (early and late) of PS placement using the postoperative computed tomography (CT) scans and compare to children with spinal deformity aged more than 10 years.
Methods: 318 patients (34 males and 284 females) underwent 6358 PS fixations for a pediatric spinal deformities at a single institution. The average age of patients was 6 years and 2 months (less than 10 y.o.) and 14 years and 3 months (more than 10 y.o.). These patients underwent postoperative CT scan which was assessed by two independent observers (spine surgeons) not involved in the treatment.
Results: Breach rate was 5,92% (377/6358 screws) for all pedicles. There were 1,47 % lateral and 3,12 % medial breaches for all pedicles with tapping canal, 2,66 % lateral and 3,84 % medial breaches for all pedicles without tapping canal for screw. Of the 6358 screws placed in the thoracic, lumbar and sacral spine, 98 % of the screws were accurately placed (grade 0, 1 and juxta pedicular). 56 screws (0,88%) had breached more than 4 mm (grade 3) and were replacement in the same course of surgery or during back to OR. No neurological, vascular or visceral complications were encountered. The accuracy of screw placement for severe scoliosis more than 90 degrees was 95 %.
Conclusion : The accuracy of PS placement in pedicles and vertebral bodies were 98 % and there was no complication related to screw placement. 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.
