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Accuracy of Pedicle Screw Placement in Children 10 Years or Younger Using Navigation and Intraoperative CT

Luo, Tianyi D. BS, MD; Polly, David W. Jr MD; Ledonio, Charles G. MD; Wetjen, Nicholas M. MD; Larson, A. Noelle MD

doi: 10.1097/BSD.0000000000000230

Study Design: A consecutive case series.

Objective: To determine the revision rate for pedicle screws placed using intraoperative CT and image-guided navigation in children 10 years or younger.

Summary of Background Data: Screws are frequently used for spinal instrumentation in young children, although this is only by physician-directed use. This is a multicenter retrospective study of patients aged 10 years or younger, who underwent spinal screw instrumentation with image-guided navigation. We hypothesized that intraoperative navigation would result in a high rate of accuracy for screw placement.

Methods: Between 2007 and 2013, 130 pedicle and 7 lateral mass screws were placed in 16 consecutive patients undergoing a total of 17 surgeries at 2 institutions. Mean age at surgery was 6.9 years (range, 0.8–10.9 y). Screws were placed using an open technique with intraoperative CT (O-arm) and image-guided navigation (Stealth). Procedures included: growing spine device (3), hemivertebrae excision (4), posterior fusion (7), cervical fusion (2), and vertebral column resection (1). Congenital deformity was the most common diagnosis. Primary outcome measures were need for intraoperative screw revision or complication associated with screw placement.

Results: Mean number of screws used per procedure was 8.1 (range, 2–17). Screws were placed from C1 to L5. Of the 137 screws, 3 required revision to shorter screws for an overall accuracy rate of 97.8%. In 1 case, a right T3 screw was revised due to anterior penetration. In another case, left-sided T1 and T2 pedicle screws were shortened 5 mm because they had penetrated the anterior aspect of their respective vertebral bodies. There were no screw-related complications.

Conclusions: In this series, image-guided navigation resulted in accurate placement of screws in patients aged 10 years or younger with no associated intraoperative complications. The navigated accuracy rate (97.8%) is significantly higher (P=0.01) than the reported 90.9% pedicle screw accuracy rate without navigation in the same age group by Baghdadi and colleagues. Intraoperative CT and image guidance were useful in our practice for placement of screws in skeletally immature patients.

*Department of Orthopedic Surgery, Mayo Clinic, Rochester

Department of Orthopaedic Surgery, University of Minnesota, Minneapolis

Department of Neurosurgery, Mayo Clinic, Rochester, MN

The authors declare no conflict of interest.

Reprints: A. Noelle Larson, MD, Department of Orthopedic Surgery, Mayo Clinic, 200 1st St SW, Rochester, MN 55905 (e-mail:

Received June 8, 2014

Accepted November 17, 2014

© 2016 by Lippincott Williams & Wilkins, Inc.