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-yearold 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.