The effect of pedicle screw instrumentation at a young age on upper thoracic vertebra and canal development

Nan Wu; Lian Liu; Guilin Chen; Shengru Wang; Yang Yang; Zhihong Wu; Terry Jianguo Zhang

doi:10.1016/j.spinee.2023.05.004

The effect of pedicle screw instrumentation at a young age on upper thoracic vertebra and canal development

Spine J. 2023 Sep;23(9):1358-1364. doi: 10.1016/j.spinee.2023.05.004. Epub 2023 May 19.

Authors

Nan Wu¹, Lian Liu², Guilin Chen³, Shengru Wang⁴, Yang Yang⁴, Zhihong Wu⁵, Terry Jianguo Zhang⁶

Affiliations

¹ Department of Orthopedic Surgery, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing 100730, China; Beijing Key Laboratory for Genetic Research of Skeletal Deformity, Beijing, 100730, China; Key Laboratory of Big Data for Spinal Deformities, Chinese Academy of Medical Sciences, Beijing, 100730, China. Electronic address: dr.wunan@pumch.cn.
² Department of Orthopedic Surgery, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing 100730, China; Beijing Key Laboratory for Genetic Research of Skeletal Deformity, Beijing, 100730, China; Key Laboratory of Big Data for Spinal Deformities, Chinese Academy of Medical Sciences, Beijing, 100730, China; Department of Emergency Surgery, Qilu Hospital of Shandong University, Jinan, Shandong Province, People's Republic of China.
³ Department of Orthopedic Surgery, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing 100730, China; Beijing Key Laboratory for Genetic Research of Skeletal Deformity, Beijing, 100730, China; Key Laboratory of Big Data for Spinal Deformities, Chinese Academy of Medical Sciences, Beijing, 100730, China; Graduate School of Peking Union Medical College, Beijing, 100730, China.
⁴ Department of Orthopedic Surgery, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing 100730, China; Beijing Key Laboratory for Genetic Research of Skeletal Deformity, Beijing, 100730, China; Key Laboratory of Big Data for Spinal Deformities, Chinese Academy of Medical Sciences, Beijing, 100730, China.
⁵ Department of Orthopedic Surgery, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing 100730, China; Beijing Key Laboratory for Genetic Research of Skeletal Deformity, Beijing, 100730, China; Key Laboratory of Big Data for Spinal Deformities, Chinese Academy of Medical Sciences, Beijing, 100730, China; Medical Research Center, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, 100730, China.
⁶ Department of Orthopedic Surgery, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing 100730, China; Beijing Key Laboratory for Genetic Research of Skeletal Deformity, Beijing, 100730, China; Key Laboratory of Big Data for Spinal Deformities, Chinese Academy of Medical Sciences, Beijing, 100730, China. Electronic address: jgzhang_pumch@yahoo.com.

PMID: 37209967
DOI: 10.1016/j.spinee.2023.05.004

Abstract

Background context: Pedicle screws are widely used in spinal surgeries. Pedicle screw fixation has shown better clinical effects than other techniques by providing steady fixation from the posterior arch to the vertebral body. However, there are several concerns about the impact of pedicle screw instrumentation insertion on vertebral development in young children, including early closure of the neurocentral cartilage (NCC). The effect of pedicle screw insertion in an early age on further growth of the upper thoracic spine is still unclear.

Purpose: This study aimed to evaluate the impact of pedicle screw insertion on further growth of the upper thoracic vertebra and spinal canal.

Study design: A retrospective case study.

Patient sample: Twenty-eight patients.

Outcome measurements: X-ray and CT parameters including length, height and area of the vertebrae and spinal canal were manually measured.

Methods: Twenty-eight patients who underwent pedicle screw fixation (T1-T6) before the age of 5 years from March 2005 to August 2019 at Peking Union Medical College Hospital were recruited, and records were retrospectively reviewed. Vertebral body and spinal canal parameters were measured at instrumented and adjacent noninstrumented levels and compared using statistical methods.

Results: Ninety-seven segments met the inclusion criteria (average age at instrumentation 44.57 months, range from 23-60 months). Thirty-nine segments had no screws, and 58 had at least one screw. There was no significant difference between the preoperative and final follow-up values of the measurement of vertebral body parameters. No significant difference was observed between the growth rates in levels with or without screws in pedicle length, vertebral body diameter, or spinal canal parameters.

Conclusion: Pedicle screw instrumentation in the upper thoracic spine does not cause a negative effect on the development of the vertebral body and spinal canal in children younger than 5 years old.

Keywords: Congenital scoliosis; Pedicle instrumentation; Spinal canal; Upper thoracic spine.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Child
Child, Preschool
Humans
Infant
Pedicle Screws* / adverse effects
Radiography
Retrospective Studies
Spinal Canal
Spinal Fusion* / methods
Thoracic Vertebrae / diagnostic imaging
Thoracic Vertebrae / surgery
Treatment Outcome