Takahito Fujimori (Department of Orthopedic Surgery, Rady’s Children’s Hospital, San Diego, USA) and others report in Spine that pedicle screws can be used in infantile or juvenile patients because although the rate of pedicle screw complications is slightly higher in these patients compared with older age groups, the rate is not significantly higher and is low overall.
Fujimori et al comment that—given the challenges of using spinal instrumentation in paediatric spinal deformity (eg. smaller anatomic size)—identifying the implant with best fixation that balances the risks and the benefits is “critical” in younger patients. They add that as more information regarding the safety of pedicle screw use in children younger than 10 years is warranted, they examined the rate of pedicle screw complications among a cohort of 99 patients aged ≤10 years treated with cervical, thoracic, and/or lumbar pedicle screws (31 aged 0–5 years and 68 aged 5–10 years) compared with the rates of such complications in 234 patients aged 10–15 years.
Across the whole patient cohort, seven patients experienced pedicle screw complications (one in the 0–5 group, two in the 5–10 group, and four in the 10–15 group); therefore, the overall rate of pedicle screw complications per patient was 2.1% and was 0.14% per screw. Fujimori et al report that there were “no neurological complications obviously caused by misplacement of the pedicle screws” but add that three of the seven patients required revision surgery.
The rate of pedicle screw complications per patient and per screw was 3.2% and 0.6%, respectively, in the 0–5 age group compared with 2.9% and 0.3% in the 5–10 group and 1.7% and 0.1% in the 10–15 group. However, none of these differences in rates were significant (p>0.5 for per patient comparison and p>0.067 for per screw comparison). The authors note that the relative risk of pedicle screw complications per patient was 1.9 in the 0–5 group and was 1.7 in the 5–10 group compared with the 10–15 group (neither comparison showing a significant difference), and that the relative risk of pedicle screw complications per screw was 5.9 in the 0–5 group and 3.2 in the 5–10 group compared with 10–15 group (again, neither comparison showing a significant difference)
Fujimori et al conclude: “We were unable to detect significant differences in the pedicle screw associated complication rates either per patient or per screw between the three groups; however, there was a trend for higher rates in the younger ages we were underpowered to detect. The usage of pedicle screws for infantile or juvenile spinal deformities can be utilised with anticipated complication rates that are not drastically different than those reported for adolescents.”
Study author Peter Newton (Department of Orthopedic Surgery, Rady’s Children’s Hospital, San Diego, USA) told Spinal News International: “Just as in adolescent patients, pedicle screws provide secure spinal fixation in children and juvenile patients as well. Careful planning and more liberal use of intraoperative imaging may be required to accurately place pedicle screws in younger (smaller) patients compared to adolescents. Accurate screw placement is only half the battle as many of the younger patients are receiving growth friendly instrumentation systems that may prolong the stress these implants must handle over time. Despite these challenges, pedicle screw complication rates in these younger patients are low and pedicle screws often represent the best available anchor option for some of our most challenging deformity cases.”