title: Safety of cervical pedicle screw insertion in children: a clinicoradiological evaluation of computer-assisted insertion of 51 cervical pedicle screws including 28 subaxial pedicle screws in 16 children.
abstract: METHODS
  Prospective clinical and radiological analysis of children with complex cervical deformities for the safety of cervical pedicle screw insertion.
  
  
  OBJECTIVE
  To analyze the possibility, safety, and efficacy of cervical pedicle screw insertion in complex pediatric cervical deformities for which conventional stabilization techniques would not have provided rigid fixation.
  
  
  BACKGROUND
  Although the use of cervical pedicle screws (CPS) in adults has become established, the feasibility and safety of their application in children have not been described previously in the literature.
  
  
  METHODS
  Sixteen children of mean age 9.7 ± 2.6 years (range: 3-13) requiring spinal stabilization for craniovertebral junction anomalies (n = 10), cervicothoracic kyphosis/kyphoscoliosis (n = 5), and cervical tumor excision (n = 1) formed the study group. Feasibility of CPS insertion was assessed by computer tomography (CT) images. Standard 3.0-mm titanium pedicle screws were inserted using intraoperative Iso-C C-arm-based 3-dimensional computer navigation, and the containment was postoperatively evaluated with CT scan.
  
  
  RESULTS
  On the basis of preoperative CT imaging, 55 pedicles were selected for screw fixation. Intraoperatively, CPS was successfully inserted at 51 levels; at 4 sclerosed pedicles (7.3%), screws could not be inserted. At 42 levels, the screws were inserted in the classical description of pedicle screw application; in 9 deformed vertebra, the screws were inserted in a nonclassical fashion, taking purchase in the 3 columns of the cervical vertebra. Forty-five (88.3%) screws were fully contained, 6 (11.7%) had a noncritical breach, and none had a critical breach. No perioperative complications related to pedicle screw insertion were noted.
  
  
  CONCLUSIONS
  Safe insertion of cervical pedicle screws is possible in children. Iso-C navigation provides real-time virtual imaging and improves the safety and accuracy of successful pedicle fixation even in altered vertebral anatomy. Pedicle width morphometrics do not restrict screw insertion.
authors.affiliation: From the Department of Orthopaedics, Traumatology and Spine Surgery, Ganga Hospital, Coimbatore, India.
authors.forename: S
authors.initials: S
authors.lastname: Rajasekaran
authors.forename: P Rishi Mugesh
authors.initials: PR
authors.lastname: Kanna
authors.forename: Ajoy Prasad
authors.initials: AP
authors.lastname: Shetty
mesh_terms: D000293:Adolescent; D001863:Bone Screws / Q000009:adverse effects*; D002574:Cervical Vertebrae / Q000002:abnormalities / Q000601:surgery*; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D016268:Internal Fixators; D007431:Intraoperative Complications; D008297:Male; D011183:Postoperative Complications; D011446:Prospective Studies; D013122:Spinal Diseases / Q000473:pathology / Q000601:surgery*; D013123:Spinal Fusion / Q000009:adverse effects / Q000295:instrumentation* / Q000379:methods