1. DOES PEDICULE SCREW FIXATION UNDER AGE FIVE CAUSE SPINAL CANAL NARROWING? A CT STUDY Cagatay OZTURK, MD Ahmet ALANAY, MD Mehmet TEZER, MD Meric ENERCAN, MD Levent ULUSOY, MD Azmi HAMZAOGLU, MD Istanbul Spine Center Florence Nightingale Hospital Istanbul-TURKEY

2. PEDICLE SCREWS USE UNDER AGE 5 iatrogenic spinal stenosis and vertebral growth arrest? is controversial to cause Ruf M, Harms J, Spine 2002 Clinical study with plain x-ray NOYES Animal study Pekmezci M, Spine 2009

3. To evaluate the changes in the canal area in a group of patients who had pedicle screw fixation under age 5 for the treatment of spinal deformity. PURPOSE

4. 10 patients operated due to spinal deformity under age 5 CT examination due to several reasons at least 2 years after the initial spinal operation PATIENT SAMPLE

5. All had congenital scoliosis Hemivertebrectomy and transpedicular fixation at an average age of 3.06 (range; 2 to 4). All had preoperative CT to evaluate the congenital deformities. METHODS

6. Measurements anterior vertebral body height (AVBH) posterior vertebral body height (PVBH) cranial end plate length (CrEPL) caudal end plate length (CaEPL) spinal canal area (SCA) anteroposterior diameter of vertebral body (APD) lateral diameter of vertebral body (LD) METHODS

7. upper instrumented vertebra (UIV) lower instrumented vertebra (LIV) upper adjacent uninstrumented vertebra (UAV) lower adjacent uninstrumented vertebra (LAV) METHODS

8. The average follow-up3.4 (2-8) years. Seven of the patients were over age 5 during the final CT examination while 3 were at age 4. Female to male ratio7 to 3 Measurement of all the parameters in 20 instrumented and 20 non-instrumented segments showed a proportional increase rather than a decrease at each segment. RESULTS

10. MS, 2y, F, congenital kyphoscoliosis, hemivertebra 0° 32° 15° -10° +5y

11. MS, 2y, F, congenital kyphoscoliosis, hemivertebra T11 T12 L1 L2 204 mm2 218 mm2 232 mm2 254 mm2 +5y T11 T12 L1 L2 220 mm2 246 mm2 266 mm2 274 mm2

12. EES, 1.5y, M +3y

13. EES, 3y, M T9 T10 T11 T12 191 mm2 192 mm2 204 mm2 206mm2 +3y 215 mm2 208 mm2 238 mm2 251mm2 T9 T10 T11 T12

14. Pedicle screw instrumentation under age 5 has no adverse effect on further spinal growth not result in iatrogenic spinal canal stenosis CONCLUSION

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