• S Rajasekaran, P Rishi Mugesh Kanna, and Ajoy Prasad Shetty.
• From the Department of Orthopaedics, Traumatology and Spine Surgery, Ganga Hospital, Coimbatore, India.
• Spine. 2012 Feb 15; 37 (4): E216-23.

Study DesignProspective clinical and radiological analysis of children with complex cervical deformities for the safety of cervical pedicle screw insertion.ObjectiveTo 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.Summary Of Background DataAlthough 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.MethodsSixteen 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.ResultsOn 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.ConclusionSafe 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.

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