Intralaminar Screw Insertion of Thoracic Spine in Children With Severe Spinal Deformities: Two Case Reports

Study Design. Case report. Objective. To describe a technique of thoracic fixation in pediatric cases with anatomy not amenable to hooks and pedicle screws. Summary of Background Data. Intralaminar screws have been described in cervical and lumbar spines. There is only 1 report of the use of thoracic intralaminar screws being used for kyphotic deformity in adult patients. Methods. We performed fixation of the thoracic spine using laminar screws in 2 patients with severe spinal deformities in whom pedicle screws and hooks failed to maintain the desired correction. Clinical and radiologic features of both cases are reported. The surgical technique is described. Results. Intralaminar screws of the thoracic spine were successfully placed in 2 children with severe spinal deformities to achieve proximal fixation. Neither dorsal nor ventral cortical bone violations of the laminae were identified. In 1 case, pedicles were too small and sclerotic to accommodate pedicle screws. The second case was characterized by pedicle screw pull-out after corrective procedure, and the following revision with hooks caused fracture of the lamina. The intralaminar screws were subsequently used as proximal fixation to correct the deformity. No screw failure was encountered. Neither patient developed neurologic complications as a result of the screws. Conclusions. This procedure was used as a salvage technique in this series. However, our experience outlines the applicability of this technique at different thoracic levels and appears to be a useful tool in the armamentarium of the spinal surgeon dealing with patients with complex spinal deformities and difficult anatomy.

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