Safety of pedicle screws and spinal instrumentation for pediatric patients: comparative analysis between 0- and 5-year-old, 5- and 10-year-old, and 10- and 15-year-old patients.

STUDY DESIGN: Retrospective study.

OBJECTIVE: To investigate the safety of pedicle screws and constructs for infantile and juvenile patients with spinal deformity.

SUMMARY OF BACKGROUND DATA: Few studies have examined the safety and complication rates associated with the usage of pedicle screw for children younger than 10 years.

METHODS: Radiographical and clinical data were collected of patients treated with pedicle screws at a single institution. Patients were divided into 2 groups based on age (0-5 yr old, 5-10 yr) and compared with an older cohort of 10- to 15-year-old patients. Patient demographics, screw adjustment, and complication data were collected for each group. Outcomes were analyzed using analysis of variance (P < 0.05).

RESULTS: In total, 5054 pedicle screws were analyzed: 176 in the 0- to 5-year-old group (31 patients), 659 in the 5- to 10-year-old group (68 patients), and 4219 in the 10- to 15-year-old group (234 patients). Mean follow-up was 3.1 ± 1.8 years (range, 3 mo-9 yr). There were 7 pedicle screw-associated complications (3 required revision surgery). Overall pedicle screw-associated complication rates were 2.1% per patient and 0.1% per screw. There were no neurological complications associated with misplacement of a pedicle screw. The pedicle screw-associated complication rates per patient and per screw were 3.2% and 0.6% in the 0- to 5-year-old group, 2.9% and 0.3% in the 5- to 10-year-old group, and 1.7% and 0.1% in the 10- to 15-year-old group (P > 0.05). The 5- to 10-year-old group had a significantly higher overall surgically related complication rate (34%) than the 0- to 5-year-old group (7%) and the 10- to 15-year-old group (6%) (P = 0.005), primarily due to the "growth friendly" constructs common in this age group.

CONCLUSION: Pedicle screws can be used for infantile or juvenile patients, although complication rates associated with pedicle screws tended to be slightly higher in the younger groups.