Transcript Document
DOES PEDICULE SCREW FIXATION UNDER AGE
FIVE CAUSE SPINAL CANAL NARROWING? A CT
STUDY
Cagatay OZTURK, MD
Ahmet ALANAY, MD
Mehmet TEZER, MD
Meric ENERCAN, MD
Levent ULUSOY, MD
Azmi HAMZAOGLU, MD
Istanbul Spine Center
Florence Nightingale Hospital
Istanbul-TURKEY
PEDICLE SCREWS USE UNDER AGE 5
is controversial to cause
iatrogenic spinal stenosis and
vertebral growth arrest?
YES
Animal study
Pekmezci M, Spine 2009
NO
Clinical study with plain x-ray
Ruf M, Harms J, Spine 2002
PURPOSE
To evaluate the changes in the canal area in a
group of patients who had pedicle screw fixation
under age 5 for the treatment of spinal deformity.
PATIENT SAMPLE
10 patients operated due to spinal deformity under age 5
CT examination due to several reasons at least 2 years
after the initial spinal operation
METHODS
All had congenital scoliosis
Hemivertebrectomy and transpedicular fixation at an
average age of 3.06 (range; 2 to 4).
All had preoperative CT to evaluate the congenital
deformities.
METHODS
Measurements
anterior vertebral body height (AVBH)
posterior vertebral body height (PVBH)
cranial end plate length (CrEPL)
caudal end plate length (CaEPL)
spinal canal area (SCA)
anteroposterior diameter of vertebral body (APD)
lateral diameter of vertebral body (LD)
METHODS
upper instrumented vertebra (UIV)
lower instrumented vertebra (LIV)
upper adjacent uninstrumented vertebra (UAV)
lower adjacent uninstrumented vertebra (LAV)
RESULTS
The average follow-up
3.4 (2-8) years.
Seven of the patients were over age 5 during the final CT
examination while 3 were at age 4.
Female to male ratio
7 to 3
Measurement of all the parameters in 20 instrumented
and 20 non-instrumented segments showed a
proportional increase rather than a decrease at each
segment.
MS, 2y, F, congenital kyphoscoliosis, hemivertebra
32°
0°
-10°
15°
+5y
+5y
MS, 2y, F, congenital kyphoscoliosis, hemivertebra
T11
204 mm2
T11
220 mm2
T12
246 mm2
L1
266 mm2
+5y
T12
218 mm2
+5y
L1
232 mm2
+5y
254 mm2
274 mm2
L2
L2
+5y
EES, 1.5y, M
+3y
+3y
EES, 3y, M
T9
T9
+3y
191 mm2
215 mm2
T10
T10
+3y
192 mm2
208 mm2
T11
T11
+3y
204 mm2
238 mm2
T12
T12
+3y
206mm2
251mm2
CONCLUSION
Pedicle screw instrumentation under age 5 has
no adverse effect on further spinal growth
not result in iatrogenic spinal canal stenosis
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