A pilot study of influence of pedicle screw instrumentation on immature vertebra: a minimal 5-year follow-up in children younger than 5 years

2019 ◽  
Vol 23 (6) ◽  
pp. 680-687
Author(s):  
Yanbin Zhang ◽  
Qifeng Peng ◽  
Shengru Wang ◽  
Yang Yang ◽  
Guanfeng Lin ◽  
...  
Keyword(s):  
Pedicle Screw ◽  
Vertebral Body ◽  
Spinal Canal ◽  
Shape Change ◽  
Lumbar Region ◽  
Pedicle Screw Instrumentation ◽  
Anteroposterior Diameter ◽  
Pedicle Length ◽  
Immature Spine

OBJECTIVEConcerns remain over the influence of pedicle screw instrumentation on the growth potential of an immature spine. Previous studies have reported discrepancies between animal experiments and clinical studies. The authors’ objective was to explore the influence of pedicle screw instrumentation on the growth of an immature spine at a very young age.METHODSIndividuals who met the authors’ criteria were included. Anteroposterior diameter of the vertebral body; pedicle length on both sides; and anteroposterior diameter, transverse diameter, and area of the spinal canal were measured on CT images before surgery and at the final follow-up. Parameters of instrumented vertebrae and adjacent noninstrumented vertebrae were compared. The growth value and growth percentage of each parameter were calculated. Subgroup comparisons were made in thoracic vertebrae and lumbar vertebrae. Statistical analyses were performed.RESULTSThirteen patients with a congenital spinal deformity were included in the study. The average age at surgery was 3.4 (range 2–5) years, and the average follow-up was 7.2 (range 5–11) years. Osteotomy and short instrumentation with pedicle screws were performed in each case. A total of 69 segments were measured, including 43 instrumented vertebrae and 26 immediately adjacent noninstrumented vertebrae. Significant increases in all parameters were noted at the final follow-up. In instrumented vertebrae, growth of the pedicle length and the anteroposterior diameter and area of the spinal canal increased significantly, while growth of the anteroposterior diameter of the vertebral body decreased significantly compared with noninstrumented vertebrae. Similar results were noted in the lumbar region. The shape-change phenomenon was found in noninstrumented vertebrae but was not apparent in instrumented vertebrae.CONCLUSIONSPedicle screw instrumentation may slow down growth of the vertebral body, indirectly speed up growth of the spinal canal, and hinder the shape-change phenomenon of the lumbar spinal canal. However, the influences were quite slight, and significant development did occur in instrumented vertebrae. Therefore, pedicle screw instrumentation may not have much effect on the growth of immature vertebrae in children younger than 5 years.

scholarly journals Impact of Pedicle Screw Instrumentation with Addition of Crosslink on Growth of Spinal Canal in Young Children

2015 ◽  
Vol 5 (1_suppl) ◽  
pp. s-0035-1554365-s-0035-1554365
Author(s):  
Zhong-Hui Chen ◽  
Xu Sun ◽  
Bin Wang ◽  
Bang-Ping Qian ◽  
Yang Yu ◽  
...  
Keyword(s):  
Young Children ◽  
Pedicle Screw ◽  
Spinal Canal ◽  
Pedicle Screw Instrumentation

Treatment of neoplastic epidural cord compression by vertebral body resection and stabilization

1985 ◽  
Vol 63 (5) ◽  
pp. 676-684 ◽  
Author(s):  
Narayan Sundaresan ◽  
Joseph H. Galicich ◽  
Joseph M. Lane ◽  
Manjit S. Bains ◽  
Patricia McCormack
Keyword(s):  
Vertebral Body ◽  
De Novo ◽  
Cord Compression ◽  
Cervical Region ◽  
Lumbar Region ◽  
Content Type ◽  
Prior Therapy ◽  
Results Of Treatment ◽  
Experienced Pain

✓ The results of treatment of neoplastic spinal cord compression by vertebral body resection and immediate stabilization in 101 consecutive patients over a 5-year period have been analyzed. Sites of primary cancer included the lung (25 patients), kidney (15 patients), breast (14 patients), connective tissue (12 patients), and a variety of others (35 patients). Of the 101 patients, 23 received surgery de novo; the remaining 78 patients had undergone previous therapy. Sites of involvement included the cervical region in 13 patients, the thoracic region in 68 patients, and the lumbar region in 20 patients. Prior to surgery, severe pain was noted in 90% of the patients, and 45% were non-ambulatory. Using an anterolateral surgical exposure, the vertebral body was resected along with all epidural tumor. Immediate stabilization was achieved with methyl methacrylate and Steinmann pins. Following surgery, the overall ambulation rate was 78%, and 85% of patients experienced pain relief. Of the 23 patients who had received no prior therapy, 90% continued to be ambulatory at their last follow-up examination or until death. The authors believe that surgery prior to irradiation is indicated in selected patients with neoplastic cord compression. In patients with solitary osseous metastasis to the spine, potentially curative resection can be undertaken if surgery is performed when the tumor is still confined to the vertebral body.

scholarly journals Morphometry of Dry Sub Axial Vertebra: A Nepalese Study

2021 ◽  
Vol 23 (1) ◽  
pp. 48-54
Author(s):  
Arun Dhakal ◽  
P Adhikari ◽  
N Ranjit ◽  
D Budhathoki
Keyword(s):  
Vertebral Body ◽  
Spinal Canal ◽  
Spinous Process ◽  
Local Population ◽  
Uncinate Process ◽  
The Body ◽  
Reference Database ◽  
Transverse Diameter ◽  
Anteroposterior Diameter ◽  
Process Length

There is paucity in literature describing the morphology of sub-axial vertebra of the local population. Available studies are limited to the body, intervertebral disk, spinal canal and Torg’s ratio of the cervical vertebra. Therefore, the present study aims to document various morphological parameters of sub axial vertebra. Sixty-four dry sub-axial vertebrae of the Nepalese population were studied using Vernier Calipers calibrated to 0.1 mm accuracy. Paired parameters of pedicle, lamina, uncinate process, the distance of the apex of the uncinate process to intervertebral foramen and foramen transversarium were measured. Similarly, unpaired parameters including spinous process length, vertebral foramen anteroposterior width, vertebral foramen transverse diameter and Torg’s ratio were evaluated. Except the height of left lamina of C3 to C6 vertebrae, none of the parameters showed significant side differences. Significant higher values of C7 were noted against C3-C6 on vertebral body height, vertebral body anteroposterior diameter, spinous process length and vertebral foramen anteroposterior diameter. Population data of sub-axial vertebra available in literature showed mixed results with ours. Interestingly, our observations either compared to (lamina, uncinate process, anteroposterior diameter of spinal canal and Torg’s ratio) or were larger (Pedicle and spinous process) than the Indian study with pedicle axis length being largest among all the compared studies. The information of this study may be used as a reference database for our local setting and could be of value in preoperative planning and in designing implants.

Indirect Spinal Canal Decompression in Burst Fractures Treated With Pedicle Screw Instrumentation

Spine ◽  
1996 ◽  
Vol 21 (1) ◽  
pp. 113-123 ◽  
Author(s):  
Lennart Sjöström ◽  
Göran Karlström ◽  
Peter Pech ◽  
Wolfgang Rauschning
Keyword(s):  
Pedicle Screw ◽  
Spinal Canal ◽  
Pedicle Screw Instrumentation ◽  
Burst Fractures

scholarly journals Complete percutaneous treatment of vertebral body tumors causing spinal canal compromise using a transpedicular cavitation, cement augmentation, and radiosurgical technique

2009 ◽  
Vol 27 (6) ◽  
pp. E9 ◽  
Author(s):  
Peter C. Gerszten ◽  
Edward A. Monaco
Keyword(s):  
Vertebral Body ◽  
Spinal Canal ◽  
Open Surgery ◽  
Cement Augmentation ◽  
Compression Fractures ◽  
Fracture Stabilization ◽  
Spinal Radiosurgery ◽  
Treatment Paradigm

Object Patients with symptomatic pathological compression fractures require spinal stabilization surgery for mechanical back pain control and radiation therapy for the underlying malignant process. Spinal radiosurgery provides excellent long-term radiographic control for vertebral metastases. Percutaneous cement augmentation using polymethylmethacrylate (PMMA) may be contraindicated in lesions with spinal canal compromise due to the risk of displacement of tumor resulting in spinal cord or cauda equina injury. However, there is also significant morbidity associated with open corpectomy procedures in patients with metastatic cancer, especially in those who subsequently require adjuvant radiotherapy. This study evaluated a treatment paradigm for malignant vertebral compression fractures consisting of transpedicular coblation corpectomy combined with closed fracture reduction and fixation, followed by spinal radiosurgery. Methods Eleven patients (6 men and 5 women, mean age 58 years) with symptomatic vertebral body metastatic tumors associated with moderate spinal canal compromise were included in this study (8 thoracic levels, 3 lumbar levels). Primary histologies included 4 lung, 2 breast, 2 renal, and 1 each of thyroid, bladder, and hepatocellular carcinomas. All patients underwent percutaneous transpedicular coblation corpectomy immediately followed by balloon kyphoplasty through the same 8-gauge cannula under fluoroscopic guidance. Patients subsequently underwent radiosurgery to the affected vertebral body (mean time to treatment 14 days). Postoperatively, patients were assessed for pain reduction and neurological morbidity. Results There were no complications associated with any part of the procedure. Adequate cement augmentation within the vertebral body was achieved in all cases. The mean radiosurgical tumor dose was 19 Gy covering the entire vertebral body. The procedure provided long-term pain improvement and radiographic tumor control in all patients (follow-up range 7–44 months). No patient later required open surgery. No radiation-induced toxicity or new neurological deficit occurred during the follow-up period. Conclusions This treatment paradigm for pathological fractures of percutaneous transpedicular corpectomy combined with cement augmentation followed by radiosurgery was found to be safe and clinically effective. This technique combines minimally invasive procedures that avoid the morbidity associated with open surgery while providing spinal canal decompression and immediate fracture stabilization, and then administering a single-fraction tumoricidal radiation dose.

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