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Safety of Pedicle Screws and Spinal Instrumentation for Pediatric Patients: Comparative Analysis Between 0- and 5-Year-Old, 5- and 10-Year-Old, and 10- and 15-Year-Old Patients

Fujimori, Takahito MD*,†; Yaszay, Burt MD*; Bartley, Carrie E. MA*; Bastrom, Tracey P. MA*; Newton, Peter O. MD*

doi: 10.1097/BRS.0000000000000202
Clinical Case Series

Study Design. Retrospective study.

Objective. To investigate the safety of pedicle screws and constructs for infantile and juvenile patients with spinal deformity.

Summary of Background Data. Few studies have examined the safety and complication rates associated with the usage of pedicle screw for children younger than 10 years.

Methods. Radiographical and clinical data were collected of patients treated with pedicle screws at a single institution. Patients were divided into 2 groups based on age (0–5 yr old, 5–10 yr) and compared with an older cohort of 10- to 15-year-old patients. Patient demographics, screw adjustment, and complication data were collected for each group. Outcomes were analyzed using analysis of variance (P < 0.05).

Results. In total, 5054 pedicle screws were analyzed: 176 in the 0- to 5-year-old group (31 patients), 659 in the 5- to 10-year-old group (68 patients), and 4219 in the 10- to 15-year-old group (234 patients).

Mean follow-up was 3.1 ± 1.8 years (range, 3 mo–9 yr). There were 7 pedicle screw–associated complications (3 required revision surgery). Overall pedicle screw–associated complication rates were 2.1% per patient and 0.1% per screw. There were no neurological complications associated with misplacement of a pedicle screw. The pedicle screw–associated complication rates per patient and per screw were 3.2% and 0.6% in the 0- to 5-year-old group, 2.9% and 0.3% in the 5- to 10-year-old group, and 1.7% and 0.1% in the 10- to 15-year-old group (P > 0.05). The 5- to 10-year-old group had a significantly higher overall surgically related complication rate (34%) than the 0- to 5-year-old group (7%) and the 10- to 15-year-old group (6%) (P = 0.005), primarily due to the “growth friendly” constructs common in this age group.

Conclusion. Pedicle screws can be used for infantile or juvenile patients, although complication rates associated with pedicle screws tended to be slightly higher in the younger groups.

Level of Evidence: 3

The safety of pedicle screws in pediatric patients was evaluated. Complication rates associated with pedicle screws were low in all age groups (0–5 yr, 5–10 yr, and 10–15 yr). Pedicle screws can be used for infantile or juvenile patients with anticipated screw-related complication rates that are nearly the same as those for adolescent patients.

*Department of Orthopedic Surgery, Rady Children's Hospital, San Diego, CA; and

Department of Orthopedic Surgery, Osaka University Graduate School of Medicine, Osaka, Japan.

Address correspondence and reprint requests to Peter O. Newton, MD, Department of Orthopedic Surgery, Rady Children Hospital, 3030 Children's way, Suite 410, San Diego, CA, 92123; E-mail:

Acknowledgment date: August 29, 2013. Revision date: November 14, 2013. Acceptance date: December 9, 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 commercially available in the United States. Yamada Science Foundation grant funds were received in support of this work.

Relevant financial activities outside the submitted work: consultancy, expert testimony, grants, payment for lecture, patents, royalties, employment, payment for development of educational presentations, stocks.

© 2014 by Lippincott Williams & Wilkins