title: Pedicle screws in 1- and 2-year-old children: technique, complications, and effect on further growth.
abstract: METHODS
  A retrospective study of 19 consecutive cases (1991-2001) where 91 thoracic and lumbar pedicle screws were used in the treatment of various pediatric spinal disorders in 1- and 2-year-old children.
  
  
  OBJECTIVE
  To determine the effectiveness and safety of pedicle screw fixation in very young children and to evaluate the effect of pedicle screw insertion on further growth of the vertebra.
  
  
  BACKGROUND
  Although many studies exist about the use of pedicle screws and its advantages in spinal fixation in adults and older children, no study has been published about the use of pedicle screws in 1- and 2-year-old children.
  
  
  METHODS
  A retrospective review of 19 consecutive operations in 16 patients with insertion of 91 pedicle screws for various spinal disorders in 1- and 2-year-old children was performed. The technique of screw insertion was described. Complications were divided into those directly related to screw placement and general complications and short- and long-term complications. In three cases with more than 6 years follow-up, the effect of pedicle screw insertion on further growth was evaluated by radiographic measurements.
  
  
  RESULTS
  Short-term complications occurred in two patients (one pedicle fracture, one infection) and long-term complications in three patients (one screw breakage, two failures of screw connection). Three of 91 screws were misplaced without any neurologic symptoms. Measurements of the vertebral growth in long-term follow-up did not show any adverse effect related to pedicle screw insertion.
  
  
  CONCLUSIONS
  The results suggest that pedicle screw fixation can be performed safely in 1- and 2-year-old children without negative effects on vertebral growth. In various pediatric spinal disorders, transpedicular screw fixation is the only procedure that provides a secure anchorage in short-segment instrumentation.
authors.affiliation: Department of Orthopedics and Traumatology, Center for Spinal Surgery, Klinikum Karlsbad-Langensteinbach, Karlsbad, Germany. michael.ruf@kkl.srh.de
authors.forename: Michael
authors.initials: M
authors.lastname: Ruf
authors.forename: Jürgen
authors.initials: J
authors.lastname: Harms
mesh_terms: D001863:Bone Screws / Q000009:adverse effects* / Q000706:statistics & numerical data*; D002675:Child, Preschool; D004868:Equipment Failure / Q000706:statistics & numerical data; D004869:Equipment Safety / Q000706:statistics & numerical data; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007223:Infant; D008159:Lumbar Vertebrae / Q000000981:diagnostic imaging / Q000601:surgery; D008297:Male; D011183:Postoperative Complications / Q000209:etiology*; D011859:Radiography; D012189:Retrospective Studies; D013122:Spinal Diseases / Q000601:surgery; D013123:Spinal Fusion / Q000009:adverse effects / Q000295:instrumentation* / Q000379:methods; D013131:Spine / Q000000981:diagnostic imaging / Q000254:growth & development* / Q000601:surgery; D013904:Thoracic Vertebrae / Q000000981:diagnostic imaging / Q000601:surgery; D016896:Treatment Outcome