title: The effect of pedicle screw insertion at a young age on pedicle and canal development.
abstract: METHODS
  A longitudinal case study.
  
  
  OBJECTIVE
  To determine whether pedicle screws placed in an immature spine exert effect on the continued growth of the vertebral body.
  
  
  BACKGROUND
  Pedicle screws have revolutionized surgical treatment of spinal deformities by allowing a mode of secure fixation that provides consistently better correction rates in adults and adolescents. In the young child, however, the trajectory of pedicle screws takes them through an open physis: the neurocentral cartilage. There exists little information regarding the possible effect of pedicle screws inserted at a young age on further development of the spine and the spinal canal.
  
  
  METHODS
  Patients undergoing pedicle screw instrumentation of at least 2 levels before the age of 5 years (60 mo) for the first time for any diagnosis and who had been followed for at least 24 months were included. Measurements were performed in instrumented and adjacent noninstrumented levels without visible deformity in pre- and postoperative cross-sectional images and compared using statistical methods.
  
  
  RESULTS
  Ninety segments in 15 patients met the inclusion criteria (average age at instrumentation 46.3 mo [range, 29-60 mo]). Forty segments had no screws and 50 had at least 1 screw. Pedicle length and vertebral body diameter had significantly increased in both groups, whereas spinal canal parameters did not change significantly. No significant difference was observed between the growth rates in levels with or without screws in pedicle length, vertebral body diameter, or spinal canal parameters (anterior-posterior and interpedicular diameters, and area).
  
  
  CONCLUSIONS
  Pedicle screw instrumentation performed before the age of 5 years does not cause a negative effect on the growth of pedicles, the transverse plane of the vertebral body, or the spinal canal. It can be safely performed in the treatment of deformity in this age group.
authors.affiliation: Department of Orthopaedics and Traumatology, Hacettepe University, Sihhiye, Ankara, Turkey.
authors.forename: Zeynep Deniz
authors.initials: ZD
authors.lastname: Olgun
authors.forename: Gokhan
authors.initials: G
authors.lastname: Demirkiran
authors.forename: Mehmet
authors.initials: M
authors.lastname: Ayvaz
authors.forename: Emre
authors.initials: E
authors.lastname: Karadeniz
authors.forename: Muharrem
authors.initials: M
authors.lastname: Yazici
mesh_terms: D001863:Bone Screws; D002648:Child; D002675:Child, Preschool; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D019637:Orthopedic Procedures / Q000295:instrumentation* / Q000379:methods; D017063:Outcome Assessment, Health Care; D013115:Spinal Canal / Q000254:growth & development* / Q000601:surgery*; D013122:Spinal Diseases / Q000601:surgery; D013131:Spine / Q000254:growth & development / Q000601:surgery