title: Does addition of crosslink to pedicle-screw-based instrumentation impact the development of the spinal canal in children younger than 5 years of age?
abstract: OBJECTIVE
  Use of pedicle screws has been popularized in the treatment of pediatric spinal deformity. Despite many studies regarding the effect of pedicle screws on the immature spine, there is no study concerning the impact of addition of crosslink to pedicle-screw-based instrumentation on the development of the spinal canal in young children. This study aims to determine the influence of the screw-rod-crosslink complex on the development of the spinal canal.
  
  
  METHODS
  This study reviewed 34 patients with congenital scoliosis (14 boys and 20 girls) who were treated with posterior-only hemivertebrectomy and pedicle-screw-based short-segment instrumentation before the age of 5 years. The mean age at surgery in this cohort was 37 ± 11 months (range 21-57 months). They were followed up for at least 24 months. Of these patients, 10 underwent only pedicle screw instrumentation without crosslink, and 24 with additional crosslink placement. The vertebrae were divided into three regions as follows: (1) S-CL (screw-crosslink) region, in which the vertebrae were inserted with bilateral pedicle screws and two rods connected with the crosslink; (2) S (screw) region, in which the vertebrae were inserted with bilateral pedicle screws but without crosslink; (3) NS (no screws) region, which comprised vertebrae cephalad or caudal to the instrumented region. The area, anteroposterior and transverse diameters of the spinal canal were measured at all vertebrae on the postoperative and last follow-up computed tomography axial images. The instrumentation-related parameters were also measured, including the distance between the bilateral screws and the screw base angles. The changes in the above measurements were compared between each region to evaluate the instrumentation's effect on the spinal canal growth.
  
  
  RESULTS
  The mean follow-up was 37 ± 13 months (range 24-68 months) and the mean age at the last follow-up was 74 ± 20 months (range 46-119 months). In each region, the spinal canal dimensions significantly increased during the follow-up period. There was no significant difference in the spinal canal growth rate between the S and NS regions or between the S-CL and NS regions. Besides, a comparison of the S-CL and S regions regarding the changes in the measurements of the instrumentation construct revealed no significant differences.
  
  
  CONCLUSIONS
  Pedicle-screw-based instrumentation does not cause retardation of the development of the spinal canal in young children. Moreover, use of the crosslink added to the screw-rod instrumentation also demonstrates no negative effect on the growth of the spinal canal. Thus, the addition of the crosslink to short screw-based instrumentation is recommended as an alternative to increase fixation stability in growing patients, even in very young pediatric population.
authors.affiliation: Department of Spine Surgery, Drum Tower Hospital, Medical School of Nanjing University, Zhongshan Road 321, Nanjing, 210008, China.
authors.forename: Zhong-hui
authors.initials: ZH
authors.lastname: Chen
authors.forename: Xi
authors.initials: X
authors.lastname: Chen
authors.forename: Ze-zhang
authors.initials: ZZ
authors.lastname: Zhu
authors.forename: Bin
authors.initials: B
authors.lastname: Wang
authors.forename: Bang-ping
authors.initials: BP
authors.lastname: Qian
authors.forename: Feng
authors.initials: F
authors.lastname: Zhu
authors.forename: Xu
authors.initials: X
authors.lastname: Sun
authors.forename: Yong
authors.initials: Y
authors.lastname: Qiu
mesh_terms: D002675:Child, Preschool; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007223:Infant; D008297:Male; D061330:Multidetector Computed Tomography; D065289:Pedicle Screws; D012189:Retrospective Studies; D012600:Scoliosis / Q000151:congenital / Q000601:surgery*; D013115:Spinal Canal / Q000000981:diagnostic imaging / Q000254:growth & development*; D013123:Spinal Fusion / Q000295:instrumentation* / Q000379:methods