The Efficacy And Safety Of Pedicle Screw In The Treatment Of Pediatric Spinal Tuberculosis

Chapter1:posterior pedicle screw fixation in the treatment of pediatric spinal tuberculosisObjective:To assess the efficacy of posterior pedicle screw in the treatment of pediatric spinal tuberculosis.Method:A retrospective study of21consecutive children for spinal tuberculosis was performed at on spine center. Patients undergoing pedicle screw instrumentation of at least2levels, which had been followed-up ofr at least24months were included.13patients were treated with posterior debridement, fusion and pedicle screw fixation,8patients were treated with anterior debridement,fusion and posterior pedicle screw fixation.Results:No postoperative neurological deterioration was noted. The mean follow-up duration was45.3months(range36-68months). The average age at surgery was7.1year s(1-13years).142segments in21patients met the inclusion criteria.63segments had no screws and79had at least one screw. The ASIA grade was impoved at least one grade in all patients. The mean angulation measured in21patients with kyphotic deformity was34.2±18.8°(15.7～71.9°) preoperatively, this was reduced to after surgery (p<0.05). There was a2.4°loss of correction (range1.0-3.9°) at last follow-up.Conclusion:Posterior pedicle screw system was sufficient for the prevention of loss of corrected vertebral alignment in the long term, and facilitation of early mobilization. The debridement surgery can be performed anteriorly or posteriorly after assessment of the patient.Chapter Ⅱ:The effect of pedicle screw on vertebral and spinal canal growth in pediatric spinal tuberculosisObjective:To determine the reliability of pedicle screws placed in pediatric spinal tuberculosis patients, and to evaluate the effect of pedicle screw insertion on further growth of the vertebra and spinal canal.Methods:A retrospective study of21consecutive children for spinal tuberculosis was performed at on spine center. Patients undergoing pedicle screw instrumentation of at least2levels, which had been followed-up ofr at least24months were included. Measurements were performed in instrumented and adjacent non-instrumented levels. The effect of pedicle insertion on further growth was evaluated.Results:The average age at surgery was7.1year s(1-13years).142segments in21patients met the inclusion criteria.63segments had no screws and79had at least one screw. There was a significant difference between the pre-operative and final follow-up values of the measurement of spinal canal and vertebral body parameters (p<0.05). No significant difference existed between growth rates of vertebral bodies and the sagittal diameters of spinal canal with or without screws. The growth rates of vertebral bodies in lumbar spine were higher than in thoracic spine in both instrumented and adjacent groups.Conclusion:Pedicle screw instrumentation does not cause a retardation effect on the development of vertebral bodies and the spinal canal in pediatric spinal tuberculosis at an early age. It is a safe and reliable procedure to achieve a stable fixation.