Dados do Trabalho

Título

Efficacy and security of the Lenke´s Starting point for thoracic pedicle screw placement using the freehand technique in pediatric scoliosis. A cases series study

Objetivo

To describe the rate of neurological sequelae and reoperation due to malposition of the thoracic pedicle screw in patients under 18 years old with scoliosis, analyzing the security of the more ventral starting point for thoracic pedicle screws described by Lawrence Lenke in adult patients with adult idiopathic scoliosis.

Metodologia

A cases series study with retrospective evaluation of the clinical history of pediatric patients submitted to correction surgery with pedicle screw in our department, analyzing the surgery reports, the intraoperative monitoring reports, and the postoperative images.

Resultados

A total of 39 pediatric patients were submitted to correction scoliosis surgery from December 2018 to February 2022 in our department, the median age was 16,8 years ( ranging from 13 to 18 years ) the majority of them had adolescent idiopathic scoliosis (30 patients ), neuromuscular scoliosis ( 8 patients ), and only 1 patient with congenital scoliosis. 507 thoracic pedicles were accessed using Lenke´s starting point with the freehand technique. All the patients had postoperative CT scans after the surgery to study the adequate position of pedicles screw, a total of 23 screws had a medial tract on postoperative CT scan ( 87% of them had Neuromuscular scoliosis )but only 2 patients were submitted to reoperation surgery due to neurological deterioration and postoperative pain. None patient had neurological sequelae after 3 months of follow-up.

Conclusões

Lenke´s starting point for thoracic pedicle screw placement is a safe manner to conduct a more medial and safer screw angulation in pediatric patients with scoliosis, however, it's safer in patients with adolescent idiopathic scoliosis than in patients with neuromuscular scoliosis.

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