Anatomical Feasibility of Pediatric Cervical Pedicle Screw Insertion by Computed Tomographic Morphometric Evaluation of 376 Pediatric Cervical Pedicles
Bibliographic record
Abstract
In Brief Study Design. Prospective analysis of computed tomographic images of 376 normal pediatric cervical pedicles. Objective. To study the normal cervical pedicle morphometrics, the changes in pedicle morphology with skeletal growth, and the possibility of pedicle screw insertion. Summary of Background Data. Although the usage of cervical pedicle screws in adults has become established, the feasibility of its application in children has not been studied. There are no in vivo studies that define the normal pediatric cervical pedicle morphometrics and its changes with growth and development of the child. Methods. A total of 376 normal pediatric cervical spine pedicles of 30 children (mean age = 6.7 ± 3.9 years) were analyzed for pedicle width (PW), pedicle height (PH), pedicle length (PL), pedicle axis length (PAL), transverse pedicle angle (TPA), and sagittal pedicle angle (SPA). The study population was categorized into three age groups (A: <5 years, B: 5–10 years, and C >10 years). The mean values of these parameters in the different age groups and the possibility of application cervical pedicle screws were studied. Results. The mean PW was lowest in the C3 vertebra and increased distally to be widest at C7. Sixty percent of C3 pedicles had a width less than 4 mm making screw passage risky and unsafe. With growth, the PW increased at all levels but this increase was significant only up to the age of 10 years. More than 75% of adult pedicle dimensions were achieved by 5 years of age. The mean PL at all levels remained the same with no significant increase with growth. However, the PAL showed continuous increase with growth similar to PW. The PAL also showed an increase from C3 to C7. The PH was always more than the PW at any level. Mild insignificant asymmetry was present between the right and left side pedicles in all values. Conclusion. With growth, there was a gradual increase in PW, PH, and PAL but was mainly before the age of 10 years. Majority of C3 pedicles were thin making screw fixation unsafe. However, at all other levels, the pedicle morphometrics per se were adequate and do not restrict safe application of 3-mm cervical pedicle screw. Cervical pedicle screw fixation in children has not been described previously. A total of 376 pediatric cervical pedicles of 30 children were analyzed for pedicle width, pedicle height, pedicle length, pedicle axis length, and transverse pedicle angle. Their mean values in three different age groups and changes with growth were analyzed. With growth, there was a gradual increase in pedicle width, pedicle height, and pedicle axis length but was mainly before the age of 10 years. At least 75% of adult pedicle width dimensions are achieved by 5 years of age. At most levels (82.5%), the pedicle morphometrics do not restrict safe application of screws.
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How this classification was reachedexpand
Full frame distilled prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. Learned from the 10,348 direct Codex labels and 10,348 direct Gemma labels. Candidate is the union of thresholded teacher heads; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels or direct frontier model labels.
Codex and Gemma teacher scores by category
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.001 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.000 |
| Bibliometrics | 0.001 | 0.003 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.001 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one teacher head, not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".