COMPARATIVE ASSESSMENT OF THORACIC AND LUMBAR PEDICLE SCREW FIXATION ACCURACY IN EARLY-ONSET CONGENITAL SCOLIOSIS AND ITS IMPLICATIONS FOR POSTOPERATIVE FUNCTIONAL RECOVERY

Abstract

Objective: This study evaluates the accuracy of freehand thoracolumbar pedicle screw placement in children with early-onset congenital scoliosis using CT imaging, aiming to optimize surgical strategies and enhance postoperative functional recovery in young patients. Methods: A total of 26 hospitalized children with early-onset congenital scoliosis (16 males, 10 females; aged 2–10 years, mean age 4.68 ± 2.42 years) who underwent pedicle screw fixation from December 2014 to December 2019 were retrospectively analyzed. Freehand pedicle screw insertion was performed using C-arm guidance combined with anatomical markers, covering T1–L5 vertebral levels. The accuracy of screw placement was graded based on penetration distance through the medial, lateral, or anterior bone cortex: Grade 1 (<2mm, accurate placement), Grade 2 (2–4mm, minor deviation), and Grade 3 (>4mm, significant deviation). Grades 2 and 3 were classified as abnormal placements. Postoperative complications related to screw insertion were also recorded. Results: A total of 173 pedicle screws were inserted (mean: 6.73 screws per patient). Accurate placement (Grade 1) was achieved in 143 screws (82.7%), while 30 screws (17.3%) showed abnormal placement, including 24 Grade 2 (13.9%) and 6 Grade 3 (3.5%). Abnormal placements were more common in thoracic vertebrae (Grade 2: 20; Grade 3: 5) than in lumbar vertebrae (Grade 2: 4; Grade 3: 1), with a statistically significant difference (χ² = 5.801, P < 0.05). Additionally, screw misplacement was significantly higher on the concave side (55.6%, 15/27) compared to the convex side (20.1%, 7/34); χ² = 23.047, P < 0.05. No intraoperative or postoperative complications related to screw insertion were observed. Conclusion: Freehand placement of thoracic and lumbar pedicle screws in children under 10 years of age with early-onset congenital scoliosis demonstrates high accuracy and minimal complications, supporting its safety and clinical feasibility. However, greater caution is required when placing screws in thoracic vertebrae and morphologically abnormal vertebrae, particularly on the concave side, to minimize risks and optimize spinal stability. Future research should explore the impact of pedicle screw accuracy on postoperative rehabilitation and functional mobility outcomes in pediatric scoliosis patients.