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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