Abstract
Pedicle screws as the principal anchors of instrumentation in correction of scoliosis as described by Suk 15 years ago have now gained a wide acceptance among deformity surgeons. Pedicles in the concavity of the major as well as compensatory curves are often dysplastic making screw placement occasionally problematic.
In cases of dural ectasia with dystrophic pedicles, the transpedicular screw anchorage is sometimes impossible. In 2009 Gardner et al. presented a case of NF-1 with a troublesome cervico-thoracic kyphosis where they created distal anchors by means of laminar screw fixation. In the presentation of this case, the idea is further developed.
Case
A 14 year old girl without any obvious syndromic feature underwent surgery for a 70 degree thoracic scoliosis. A preoperatively MRI showed a dural ectasia. A preoperative low dose–CT revealed dystrophic pedicles from Th4 to L4, making transpedicular screw placement problematical.
The operation was performed with the aid of an O-arm. At all levels from Th2 – L2 laminar screw fixation was used.
Postoperatively, low-dose CT showed excellent screw positioning with the exceptiuon of one proximal screw which compromised a foramem but, without any symptoms.
The postoperative course was quite uneventful and the patient was discharged at day 5days postoperatively. The correction rate was 70%.
Conclusion
In cases of scoliosis with severe dystrophic pedicles, the use of laminar screws is a good alternative to problematic transpedicular screw placement.
