Safety of Cervical Pedicle Screw Insertion in Children

Rajasekaran, S.; Kanna, P. Rishi Mugesh; Shetty, Ajoy Prasad

doi:10.1097/brs.0b013e318231bb81

Cited by 33 publications

(18 citation statements)

References 20 publications

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“…Traditional wiring techniques are biomechanically inferior to screw-based techniques, and immobilization after surgery may be more difficult for pediatric patients 8 , 12 , 19 , 21) Therefore, the anatomical dimensions of the whole cervical spine must be investigated to study the safety of screw fixation. The suggested minimum thickness needed to allow safe placement of a screw varies in the literature 4 , 5 , 18 , 23) .…”

Section: Discussionmentioning

confidence: 99%

“…After Abumi et al 1) first reported the clinical results of pedicle screw fixation for the subaxial cervical spine, many clinical applications have been executed in adult patients. Recently, Rajasekaran et al 23) reported that safe insertion of pedicle screw is possible in pediatric patients. Vara and Thompson 25) performed a cadaveric study of pediatric cervical pedicle width [mean value : 3.63 mm (C3), 3.73 mm (C4), 4.10 mm (C5), 4.58 mm (C6), 5.15 mm (C7)] with results similar ours.…”

Section: Discussionmentioning

confidence: 99%

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Anatomic Feasibility of Posterior Cervical Pedicle Screw Placement in Children: Computerized Tomographic Analysis of Children Under 10 Years Old

Lee

Hong

Kim

et al. 2014

J Korean Neurosurg Soc

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ObjectiveTo evaluate the anatomical feasibility of 3.5 mm screw into the cervical spine in the pediatric population and to establish useful guidelines for their placement.MethodsA total of 37 cervical spine computerized tomography scans (24 boys and 13 girls) were included in this study. All patients were younger than 10 years of age at the time of evaluation for the period of 2007-2011.ResultsFor the C1 screw placement, entry point height (EPH) was the most restrictive factor (47.3% patients were larger than 3.5 mm). All C2 lamina had a height larger than 3.5 mm and 68.8% (51/74) of C2 lamina had a width thicker than 3.5 mm. For C2 pedicle width, 55.4% (41/74) of cases were larger than 3.5 mm, while 58.1% (43/74) of pedicle heights were larger than 3.5 mm. For pedicle width of subaxial spine, 75.7% (C3), 73% (C4), 82.4% (C5), 89.2% (C6), and 98.1% (C7, 1/54) were greater than 3.5 mm. Mean lamina width of subaxial cervical spine was 3.1 (C3), 2.7 (C4), 2.9 (C5), 3.8 (C6), and 4.0 mm (C7), respectively. Only 34.6% (127/370) of subaxial (C3-7) lamina thickness were greater than 3.5 mm. Mean length of lateral mass for the lateral mass screw placement was 9.28 (C3), 9.08 (C4), 8.81 (C5), 8.98 (C6), and 10.38 mm (C7).ConclusionC1 lateral mass fixation could be limited by the morphometrics of lateral mass height. C2 trans-lamina approach is preferable to C2 pedicle screw fixation. In subaxial spines, pedicle screw placement was preferable to trans-lamina screw placement, except at C7.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Anatomic Feasibility of Posterior Cervical Pedicle Screw Placement in Children: Computerized Tomographic Analysis of Children Under 10 Years Old

Lee

Hong

Kim

et al. 2014

J Korean Neurosurg Soc

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“…[18] Though, uncommon studies have been undertaken regarding the use of pedicle screws in preadolescent patients. [11131920212223] Ranade et al . [19] described the accuracy of pedicle screw placement in 16 children aged less than 8 years of age as assessed by CT and reported an overall breach rate of 6.8% with no neurologic or vascular injury.…”

Section: Discussionmentioning

confidence: 99%

Accuracy and safety of free-hand pedicle screw fixation in age less than 10 years

Seo

Yim²,

Heo³

et al. 2013

IJOO

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Background: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.Materials and Methods: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.Results: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.Conclusions: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.

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“…КТ-морфометрия С 2 позвонка показала, что транспедикулярное проведение винтов размером от 3,5 на 14,0 мм в С 2 возможно у 40-70 % детей старше 2 лет [10,29], при этом ширина и высота ножки примерно одинаковы. В клинической практике транспедикулярная и интерартикулярная фиксация С 2 продемонстрировали надежность и безопасность при использовании у детей [8,13,14,17,23,26,27,37,43,46].…”

unclassified

“…Транспедикулярная фиксация С 3 -С 6 винтами диаметром 3,5 мм и более ограничена высотой ножки и возможна менее чем у трети детей [29,48], но при этом имеется успешный опыт транспедикулярной фиксации С 3 -С 6 винтами диаметром 3 мм у детей старше 6 лет [37]. Мы не используем данный метод фиксации на уровне С 3 -С 6 у детей.…”

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Posterior Instrumentation of the Cervical Spine in Children: Literature Review

Pavlova¹,

Burtsev²,

Губин³

et al. 2017

Hir. pozvonoč

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The paper presents a review of the current literature on instrumental fixation of the pediatric cervical spine and technical features of the application of described techniques in children. The posterior instrumental fixation of the cervical spine provides stability and increases fusion rates in children with cervical spine deformities or instability, and allows intraoperative reduction of vertebral displacements. A number of morphological and clinical studies proved the possibility of implantation of modern metal constructs in children. Given the small size of bone structures in children, each case requires careful preoperative planning, proper intraoperative positioning and strict adherence to surgical techniques.

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Safety of Cervical Pedicle Screw Insertion in Children

Abstract: Safe insertion of cervical pedicle screws is possible in children. Iso-C navigation provides real-time virtual imaging and improves the safety and accuracy of successful pedicle fixation even in altered vertebral anatomy. Pedicle width morphometrics do not restrict screw insertion.

Cited by 33 publications

References 20 publications

Anatomic Feasibility of Posterior Cervical Pedicle Screw Placement in Children: Computerized Tomographic Analysis of Children Under 10 Years Old

Anatomic Feasibility of Posterior Cervical Pedicle Screw Placement in Children: Computerized Tomographic Analysis of Children Under 10 Years Old

Accuracy and safety of free-hand pedicle screw fixation in age less than 10 years

Posterior Instrumentation of the Cervical Spine in Children: Literature Review

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