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Abstract from the 2006 SRS Annual Meeting
Introduction: Congenital deformities should be corrected early
before rigidity increases and before secondary structural curves develop. However,
in young children the immature posterior elements do not allow for a stable
fixation with hooks or wires. In a one or two year old child transpedicular
instrumentation is the only option which ensures stable fixation. There is,
however, a lack of long-term results regarding vertebral growth following transpedicular
instrumentation in this age group.
Methods: Twenty-two operations in 19 one and two year old
children were performed between 1991 and 2003. A total of 120 transpedicular
screws were inserted; 20 in the upper thoracic spine (T1-T4), 26 in the midthoracic
spine (T5-T9), 53 in the thoracolumbar region (T10-L1), and 21 in the lumbar
spine (L2-S1). Screw diameter was 3.5 mm. Five patients (group 1) were evaluated
with a minimum follow-up of 10 years, 14 patients (group 2) with a follow-up
of 2 to 10 years.
Results: None of the patients showed neurologic deficits,
neither by placement of the screws nor during further growth. MRI or CT studies
were performed in 3 patients of group 1; they showed no stenosis of the spinal
canal. Radiographic results demonstrated growth of the instrumented vertebral
bodies comparable to adjacent vertebrae. Complications of pedicle screws: 6
malpositions (5%), 2 screw breakages (1.7%), and one pedicle fracture (0.8%).
Discussion: The results suggest that pedicle screw fixation
can be performed safely in one and two year old children without adverse effects
on vertebral growth. Transpedicular screws allow for stable fixation with three
dimensional control of the vertebral body and transmission of adequate correction
forces. Although transpedicular screws cross the neurocentral synchondrosis,
no stenosis of the spinal canal was observed. Vertical growth of the vertebral
bodies against posterior transpedicular instrumentation, which acts as a tension
band, results in increasing lordosis.
Hibbs Award Nominee for Best Clinical Paper
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