A pilot study of influence of pedicle screw instrumentation on immature vertebra: a minimal 5-year follow-up in children younger than 5 years

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OBJECTIVE

Concerns remain over the influence of pedicle screw instrumentation on the growth potential of an immature spine. Previous studies have reported discrepancies between animal experiments and clinical studies. The authors’ objective was to explore the influence of pedicle screw instrumentation on the growth of an immature spine at a very young age.

METHODS

Individuals who met the authors’ criteria were included. Anteroposterior diameter of the vertebral body; pedicle length on both sides; and anteroposterior diameter, transverse diameter, and area of the spinal canal were measured on CT images before surgery and at the final follow-up. Parameters of instrumented vertebrae and adjacent noninstrumented vertebrae were compared. The growth value and growth percentage of each parameter were calculated. Subgroup comparisons were made in thoracic vertebrae and lumbar vertebrae. Statistical analyses were performed.

RESULTS

Thirteen patients with a congenital spinal deformity were included in the study. The average age at surgery was 3.4 (range 2–5) years, and the average follow-up was 7.2 (range 5–11) years. Osteotomy and short instrumentation with pedicle screws were performed in each case. A total of 69 segments were measured, including 43 instrumented vertebrae and 26 immediately adjacent noninstrumented vertebrae. Significant increases in all parameters were noted at the final follow-up. In instrumented vertebrae, growth of the pedicle length and the anteroposterior diameter and area of the spinal canal increased significantly, while growth of the anteroposterior diameter of the vertebral body decreased significantly compared with noninstrumented vertebrae. Similar results were noted in the lumbar region. The shape-change phenomenon was found in noninstrumented vertebrae but was not apparent in instrumented vertebrae.

CONCLUSIONS

Pedicle screw instrumentation may slow down growth of the vertebral body, indirectly speed up growth of the spinal canal, and hinder the shape-change phenomenon of the lumbar spinal canal. However, the influences were quite slight, and significant development did occur in instrumented vertebrae. Therefore, pedicle screw instrumentation may not have much effect on the growth of immature vertebrae in children younger than 5 years.

ABBREVIATIONS AP = anteroposterior; NCS = neurocentral synchondrosis; PSI = pedicle screw instrumentation; SC = spinal canal; SCAP = AP diameter of the SC; SCT = transverse diameter of the SC; VB = vertebral body; VBAP = AP diameter of the VB.

Article Information

Correspondence Jianguo Zhang: Peking Union Medical College Hospital, Beijing, People’s Republic of China. jgzhang_pumch@yahoo.com.

INCLUDE WHEN CITING Published online March 15, 2019; DOI: 10.3171/2018.12.PEDS18622.

Y.Z. and Q.P. share first authorship of this work.

Disclosures The authors report no conflict of interest concerning the materials or methods used in this study or the findings specified in this paper.

© AANS, except where prohibited by US copyright law.

Headings

Figures

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    A: Sagittal image, adjusted to be parallel to the upper endplate. B: The line between A and B is the VBAP. The line between B and C is the SCAP. The line between D and E is the SCT. The lines between F and H, and G and I are the right and left pedicle lengths, respectively. The wall of the SC defines the area of the SC. Figure is available in color online only.

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    A and B: Posteroanterior radiographs obtained in a 4-year-old girl with hemivertebrae located at T12–L1. C: Hemivertebra resection and instrumentation from T12 to L2 were performed. D: The follow-up was 106 months, and the long-term outcome was satisfactory.

  • View in gallery

    CT images obtained in the same patient as in Fig. 2. A–C: NCS was seen at the junction of the VB and pedicles before surgery. D–F: At the final follow-up, the VBAP growth values were 2.36 mm, 2.92 mm, and 9.06 mm at L1, L2, and L3, respectively. The SCAP growth values were 9.31 mm, 4.57 mm, and 4.20 mm at L1, L2, and L3, respectively. The growth values of the SC area were 190.86 mm2, 151.20 mm2, and 88.98 mm2 at L1, L2, and L3, respectively. The shape-change phenomenon is seen at L3 (C and F) but is not so obvious at L1 (A and D) and L2 (B and E).

  • View in gallery

    A and B: Radiographs obtained in a 3-year-old girl with a hemivertebra located at L2. C: Hemivertebra resection and instrumentation from L1 to L3 were performed. The follow-up was 132 months. D: Implants were removed at 81 months after surgery.

  • View in gallery

    CT images obtained in the same patient as in Fig. 4. A–C: NCS is seen before surgery. D–F: The shape-change phenomenon is apparent at L4 (C and F) but not so obvious at L1 (A and D) or L3 (B and E).

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