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Complications of Pedicle Screws in Children 10 Years or Younger: A Case Control Study

Baghdadi, Yaser M. K. MD; Larson, A. Noelle MD; McIntosh, Amy L. MD; Shaughnessy, William J. MD; Dekutoski, Mark B. MD; Stans, Anthony A. MD

doi: 10.1097/BRS.0b013e318286be5d
Clinical Case Series

Study Design. Case control study.

Objective. To determine complications associated with pedicle screw use and screw accuracy in children 10 years or younger.

Summary of Background Data. Pedicle screws are frequently used for the treatment of spine deformity in children, but, for young patients, this is only by physician-directed use. Thus, we sought to determine the rates of screw-related complications and screw malposition in patients 10 years or younger compared with a series of matched controls greater than 10 years of age.

Methods. From 2000–2011, 265 screws were placed in 33 consecutive patients undergoing a total of 35 procedures for a variety of spine deformities. Mean age at surgery was 7 years (range, 2–10) with a mean time to follow-up of 3.3 ± 2.4 years. Congenital spine deformity was the most common surgical indication. Primary outcome measures were screw-related complication or return to surgery for screw malposition. Patients were matched by diagnosis/fusion level to 66 control patients greater than 10 years of age. Available computed tomographic scans in young children were reviewed to assess screw accuracy.

Results. In patients 10 years or younger, 2 out of 265 screws (0.75%) resulted in a screw-related complication. No patient required revision surgery due to screw malposition. No patients older than 10 years in the matched controls had a screw-related complication or revision surgery due to screw malposition. Computed tomograpic data was available for 10 young patients, which was compared with data from the larger cohort of 81 older children. No difference was found in the rates of severe asymptomatic screw malposition, but moderate screw malposition was more common in the younger cohort.

Conclusion. In this limited series, 265 pedicle screws were placed in 33 patients 10 years or younger with 0.75% of pedicle screws resulting in a complication. The rates of screw malposition revealed on computed tomographic scan were similar to those of adolescent children. These data support the use of pedicle screws in children 10 years or younger for the treatment of complex spinal deformity.

Level of Evidence: 4

The use of pedicle screws in children 10 years or younger seems to be safe and reliable with a low rate of screw-related complications. There is a statistically higher rate of moderate but not severe screw malposition in younger children than children older than 10 years.

From the Mayo Clinic, Department of Orthopedic Surgery, Rochester, MN.

Address correspondence and reprint requests to A. Noelle Larson, MD, Mayo Clinic, Department of Orthopedic Surgery, 200 First Street SW, Rochester, MN 55905; E-mail:

Acknowledgment date: August 20, 2012. First revision date: November 20, 2012. Acceptance date: January 4, 2013.

The device(s)/drug(s) that is/are the subject of this manuscript is/are not FDA-approved for this indication and is/are not commercially available in the United States.

No funds were received in support of this work.

Relevant financial activities outside the submitted work: consultancy, payment for lectures, patents, royalties, and payment for development of educational presentations.

© 2013 Lippincott Williams & Wilkins, Inc.