{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,13]],"date-time":"2026-07-13T04:18:43Z","timestamp":1783916323308,"version":"3.55.0"},"reference-count":48,"publisher":"MDPI AG","issue":"16","license":[{"start":{"date-parts":[[2023,8,18]],"date-time":"2023-08-18T00:00:00Z","timestamp":1692316800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"P.G."}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>Background: A very common technique for treating spinal deformities in children and adolescents is the use of segmental screws. In order to obtain proper stability and the best possible correction, the screws must first be precisely inserted. Additional factors influencing the quality and success of the operation are the size and quality of the bone, the skills of the surgeon, and biomechanical factors, i.e., the width and length of the screws used during surgery. Our study was focused on evaluating the effect of increasing the diameter of the instrumented pedicles by pedicle screws and assessing the safety of expanding these pedicles with screws of various sizes in children with spinal deformities during the growth period, using preoperative magnetic resonance imaging and postoperative computed tomography (CT) to assess and compare preoperative size measurements from MRI to postoperative CT measurements. Methods: We obtained data for evaluation from the available medical records and treatment histories of patients aged 2 to 18 who underwent surgical treatment of spinal deformities in the years 2016\u20132023. In 230 patients (28 male and 202 female), 7954 vertebral bodies were scanned by preoperative MRI, and 5080 pedicle screws were inserted during surgery, which were then assessed by postoperative CT scan. For the most accurate assessment, patients were classified into three age groups: 2\u20135 years (Group 1), 6\u201310 years (Group 2), and 11\u201318 years (Group 3). In addition, we studied implant subgroups: vertebral bodies with inserted pedicles of screw sizes 5.0 mm and 5.5 mm (Group S), and pedicles of screw sizes 6.0 mm, 6.5 mm, and 7.0 mm (Group L). Results: The morphology of pedicles (Lenke classification) analyzed before surgery using MRI was 55.2% type A, 33.8% type B, 4.7% type C, and 6.3% type D. The postoperative lateral and medial breaches were noted, and these did not cause any complications requiring revision surgery. The mean pedicle diameter before surgery for T1\u2013L5 vertebral pedicles was between 3.79 (1.44) mm and 5.68 (1.64) mm. The mean expanding diameter of pedicles after surgery for T1\u2013L5 vertebral pedicles ranged from 1.90 (0.39) mm to 2.92 (0.28) mm, which corresponds to the extension of the pedicle diameter in the mean range of 47% (4.1)\u201371% (3.0). We noted that the mean vertebral pedicle expansion was 49% in Group 1, 52% in Group 2, and 62% in Group 3 (N.S.), and the mean expansion for 7.0 mm screw pedicles was 78%. Conclusions: Our study confirms that there is a wide range of expansion of the vertebral pedicle during screw insertion (up to 78%) with a low risk of lateral or medial breaches and without an increased risk of complications. The larger the diameter of the screw inserted into the pedicle, the more the pedicle expands. Pedicle measurements by preoperative MRI may be helpful for sufficient reliability in preoperative planning.<\/jats:p>","DOI":"10.3390\/jcm12165368","type":"journal-article","created":{"date-parts":[[2023,8,18]],"date-time":"2023-08-18T09:13:44Z","timestamp":1692350024000},"page":"5368","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":10,"title":["Influences of Increasing Pedicle Screw Diameter on Widening Vertebral Pedicle Size during Surgery in Spinal Deformities in Children and Adolescents without Higher Risk of Pedicle and Vertebral Breaches"],"prefix":"10.3390","volume":"12","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-7059-2935","authenticated-orcid":false,"given":"Pawel","family":"Grabala","sequence":"first","affiliation":[{"name":"Department of Pediatric Orthopedic Surgery and Traumatology, University Children\u2019s Hospital, Waszyngtona 17, 15-274 Bialystok, Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5200-3279","authenticated-orcid":false,"given":"Ilkka J.","family":"Helenius","sequence":"additional","affiliation":[{"name":"Department of Orthopedics and Traumatology, Helsinki University Hospital, 00260 Helsinki, Finland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michal","family":"Grabala","sequence":"additional","affiliation":[{"name":"2nd Clinical Department of General and Gastroenterogical Surgery, Medical University of Bialystok, ul. M. Sk\u0142odowskiej-Curie 24a, 15-276 Bialystok, Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Suken A.","family":"Shah","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, Nemours Children\u2019s Health, Delaware Valley, 1600 Rockland Road, Wilmington, DE 19803, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2023,8,18]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"2049","DOI":"10.1097\/00007632-200109150-00022","article-title":"Thoracic pedicle screw fixation in spinal deformities: Are they really safe?","volume":"26","author":"Suk","year":"2001","journal-title":"Spine"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"13","DOI":"10.1007\/s00586-011-1986-0","article-title":"Pedicle screw instrumentation in adolescent idiopathic scoliosis (AIS)","volume":"21","author":"Suk","year":"2011","journal-title":"Eur. Spine J."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"512","DOI":"10.4103\/0028-3886.22622","article-title":"Thoracic pedicle screw placement: Free-hand technique","volume":"53","author":"Lenke","year":"2005","journal-title":"Neurol. India"},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"448","DOI":"10.1097\/01.brs.0000255030.78293.fd","article-title":"Coronal and sagittal plane correction in adolescent idiopathic scoliosis: A comparison between all pedicle screw versus hybrid thoracic hook lumbar screw constructs","volume":"32","author":"Lowenstein","year":"2007","journal-title":"Spine"},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"490","DOI":"10.1097\/BPO.0b013e318250c629","article-title":"Comparative analysis of hook, hybrid, and pedicle screw instrumentation in the posterior treatment of adolescent idiopathic scoliosis","volume":"32","author":"Yilmaz","year":"2012","journal-title":"J. Pediatr. Orthop."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"E857","DOI":"10.1097\/BSD.0000000000000413","article-title":"All-Pedicle Screw Fixation With 6-mm-Diameter Cobalt-Chromium Rods Provides Optimized Sagittal Correction of Adolescent Idiopathic Scoliosis","volume":"30","author":"Lamerain","year":"2017","journal-title":"Clin. Spine Surg."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"2040","DOI":"10.1097\/01.brs.0000138268.12324.1a","article-title":"Comparative analysis of pedicle screw versus hook instrumentation in posterior spinal fusion of adolescent idiopathic scoliosis","volume":"29","author":"Kim","year":"2004","journal-title":"Spine"},{"key":"ref_8","doi-asserted-by":"crossref","unstructured":"Sarwahi, V., Hasan, S., Koutsogiannis, P., Visahan, K., Rao, H., Patil, A., Lo, Y., Amaral, T., and Di Mauro, J.P. (2023). Effect of Pedicle Screw Size on Surgical Outcomes Following Surgery for Adolescent Idiopathic Scoliosis. Spine, ahead of print.","DOI":"10.1097\/BRS.0000000000004700"},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"1836","DOI":"10.1097\/BRS.0b013e3181d3cfde","article-title":"A Novel Pedicle Channel Classification Describing Osseous Anatomy: How many thoracic scoliotic pedicles have cancellous channels?","volume":"35","author":"Watanabe","year":"2010","journal-title":"Spine"},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"1227","DOI":"10.2106\/JBJS.J.00678","article-title":"Pediatric pedicle screws: Comparative effectiveness and safety: A systematic literature review from the Scoliosis Research Society and the Pediatric Orthopaedic Society of North America task force","volume":"93","author":"Ledonio","year":"2011","journal-title":"J. Bone Jt. Surg. Am."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"222","DOI":"10.1097\/01.brs.0000150482.26918.d8","article-title":"Accuracy and Efficacy of Thoracic Pedicle Screws in Curves More Than 90\u00b0","volume":"30","author":"Kuklo","year":"2005","journal-title":"Spine"},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"2679","DOI":"10.1097\/BRS.0b013e31815a7f13","article-title":"Computed tomography evaluation of pedicle screw placed in the pediatric deformed spine over an 8-year period","volume":"32","author":"Lehman","year":"2007","journal-title":"Spine"},{"key":"ref_13","doi-asserted-by":"crossref","unstructured":"Grabala, P., Helenius, I.J., Kowalski, P., Grabala, M., Zacha, S., Deszczynski, J.M., Albrewczynski, T., Galgano, M.A., Buchowski, J.M., and Chamberlin, K. (2023). The Child\u2019s Age and the Size of the Curvature Do Not Affect the Accuracy of Screw Placement with the Free-Hand Technique in Spinal Deformities in Children and Adolescents. J. Clin. Med., 12.","DOI":"10.3390\/jcm12123954"},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"1203","DOI":"10.1007\/s00586-006-0281-y","article-title":"Pedicle morphology of the thoracic spine in preadolescent idiopathic scoliosis: Magnetic resonance supported analysis","volume":"16","author":"Catan","year":"2007","journal-title":"Eur. Spine J."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"371","DOI":"10.1016\/j.diii.2019.01.010","article-title":"Preoperative assessment of idiopathic scoliosis in adolescent and young adult with three-dimensional T2-weighted spin-echo MRI","volume":"100","author":"Duchaussoy","year":"2019","journal-title":"Diagn. Interv. Imaging"},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"E28","DOI":"10.1097\/BSD.0b013e318228bbed","article-title":"Polymethylmethacrylate augmentation of pedicle screws increases the initial fixa- tion in osteoporotic spine patients","volume":"25","author":"Sawakami","year":"2012","journal-title":"J. Spinal Disord. Tech."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"1740","DOI":"10.21037\/qims-22-483","article-title":"Correlation between direction of pedicle screw and restoration of lumbar degenerative scoliosis in degenerative lumbar spondylolisthesis: A retrospective study","volume":"13","author":"Zhan","year":"2023","journal-title":"Quant. Imaging Med. Surg."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"196","DOI":"10.1016\/j.jbiomech.2017.10.009","article-title":"Effect of pedicle screw diameter on screw fixation efficacy in human osteoporotic thoracic vertebrae","volume":"70","author":"Lai","year":"2018","journal-title":"J. Biomech."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"566","DOI":"10.31616\/asj.2020.0353","article-title":"Impact of Screw Diameter and Length on Pedicle Screw Fixation Strength in Osteoporotic Vertebrae: A Finite Element Analysis","volume":"15","author":"Matsukawa","year":"2021","journal-title":"Asian Spine J."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"E932","DOI":"10.1097\/BRS.0000000000004021","article-title":"Factors Affecting Pedicle Screw Insertional Torque in Spine Deformity Surgery","volume":"46","author":"Oda","year":"2021","journal-title":"Spine"},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"513","DOI":"10.1016\/j.spinee.2004.02.006","article-title":"Pedicle screw fixation strength: Pullout versus insertional torque","volume":"4","author":"Inceoglu","year":"2004","journal-title":"Spine J."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"1061","DOI":"10.1302\/0301-620X.92B8.24237","article-title":"The biomechanics of pedicle screw-based instrumentation","volume":"92","author":"Cho","year":"2010","journal-title":"J. Bone Jt. Surg. Br."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"2429","DOI":"10.1097\/00007632-199611010-00004","article-title":"Insertional torque and pull-out strengths of conical and cylindrical pedicle screws in cadaveric bone","volume":"21","author":"Kwok","year":"1996","journal-title":"Spine"},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"1869","DOI":"10.1097\/BRS.0b013e318108b912","article-title":"A pedicle screw construct gives an enhanced posterior correction of adolescent idiopathic scoliosis when compared with other constructs: Myth or reality","volume":"32","author":"Vora","year":"2007","journal-title":"Spine"},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"264","DOI":"10.1097\/00007632-199602010-00002","article-title":"Internal architecture of the thoracic pedicle. An anatomic study","volume":"21","author":"Kothe","year":"1996","journal-title":"Spine"},{"key":"ref_26","unstructured":"Rinella, A.S., Cahill, P., and Ghanayem, A. (2004, January 6). Thoracic pedicle expansion after pedicle screw placement in a pediatric cadaveric spine. Proceedings of the Podium presentation: Scoliosis Research Society (SRS) 2004 Annual Meeting, Buenos Aires, Argentina."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"E1195","DOI":"10.1097\/BRS.0000000000000514","article-title":"The effect of increasing pedicle screw size on thoracic spinal canal dimensions: An anatomic study","volume":"39","author":"Cho","year":"2014","journal-title":"Spine"},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"E826","DOI":"10.1097\/01.brs.0000240759.06855.e6","article-title":"The effect of pedicle expansion on pedicle morphology and biomechanical stability in the immature porcine spine","volume":"31","author":"Yazici","year":"2006","journal-title":"Spine"},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"2378","DOI":"10.1097\/BRS.0b013e3181b0bb9b","article-title":"The effect of dilation of immature pedicles on pullout strength of the screws: Part 2: In vivo study","volume":"34","author":"Yilmaz","year":"2009","journal-title":"Spine"},{"key":"ref_30","doi-asserted-by":"crossref","unstructured":"Grabala, P., Helenius, I.J., Chamberlin, K., and Galgano, M. (2023). Less-Invasive Approach to Early-Onset Scoliosis-Surgical Technique for Magnetically Controlled Growing Rod (MCGR) Based on Treatment of 2-Year-Old Child with Severe Scoliosis. Children, 10.","DOI":"10.3390\/children10030555"},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"104S","DOI":"10.1177\/2192568219859314","article-title":"The Use of Intraoperative Neurophysiological Monitoring in Spine Surgery","volume":"10","author":"Charalampidis","year":"2020","journal-title":"Glob. Spine J."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"588","DOI":"10.1016\/j.arcped.2022.08.014","article-title":"Intraoperative neuromonitoring in non-idiopathic pediatric scoliosis operated with minimally fusionless procedure: A series of 290 patients","volume":"29","author":"Besse","year":"2022","journal-title":"Arch. Pediatr."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"315","DOI":"10.1007\/s43390-020-00246-7","article-title":"Intraoperative neuromonitoring practice patterns in spinal deformity surgery: A global survey of the Scoliosis Research Society","volume":"9","author":"Dikmen","year":"2021","journal-title":"Spine Deform."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"22","DOI":"10.1097\/BSD.0b013e31823162ef","article-title":"Pedicle morphology using computed tomography-based navigation system in adolescent idiopathic scoliosis","volume":"26","author":"Kuraishi","year":"2013","journal-title":"J. Spinal Disord. Tech."},{"key":"ref_35","first-page":"55","article-title":"Management of juvenile idiopathic scoliosis","volume":"89","author":"Lenke","year":"2007","journal-title":"J. Bone Jt. Surg. Am."},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"11","DOI":"10.1097\/00007632-199001000-00004","article-title":"Accuracy of Pedicular Screw Placement In Vivo","volume":"15","author":"Gertzbein","year":"1990","journal-title":"Spine"},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"547","DOI":"10.1097\/01.bsd.0000211221.74307.57","article-title":"Stepwise Methodology for Plain Radiographic Assessment of Pedicle Screw Placement: A Comparison with Computed Tomography","volume":"19","author":"Choma","year":"2006","journal-title":"J. Spinal Disord. Tech."},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"361","DOI":"10.1007\/s43390-021-00434-z","article-title":"0.4% incidence of return to OR due to screw malposition in a large prospective adolescent idiopathic scoliosis database","volume":"10","author":"Swany","year":"2021","journal-title":"Spine Deform."},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"278","DOI":"10.1097\/00003086-199311000-00045","article-title":"Effect of screw diameter, insertion technique, and bone cement augmentation of pedicular screw fixation strength","volume":"296","author":"Wittenberg","year":"1993","journal-title":"Clin. Orthop. Relat. Res."},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"E386","DOI":"10.1097\/BRS.0b013e318286be5d","article-title":"Complications of pedicle screws in children 10 years or younger: A case control study","volume":"38","author":"Baghdadi","year":"2013","journal-title":"Spine"},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"E465","DOI":"10.1097\/BRS.0b013e3181d1021a","article-title":"Complications of Pedicle Screw Fixation in Scoliosis Surgery: A Systematic Review","volume":"35","author":"Hicks","year":"2010","journal-title":"Spine J."},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"333","DOI":"10.1097\/01.BRS.0000109983.12113.9B","article-title":"Free hand pedicle screw placement in the thoracic spine: Is it safe?","volume":"29","author":"Kim","year":"2004","journal-title":"Spine"},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"359","DOI":"10.2106\/00004623-200203000-00005","article-title":"Analysis of vertebral morphology in idiopathic scoliosis with use of magnetic resonance imaging and multiplanar reconstruction","volume":"84","author":"Liljenqvist","year":"2002","journal-title":"J. Bone Jt. Surg. Am."},{"key":"ref_44","doi-asserted-by":"crossref","unstructured":"Grabala, P., Helenius, I.J., Buchowski, J.M., and Shah, S.A. (2023). The Efficacy of a Posterior Approach to Surgical Correction for Neglected Idiopathic Scoliosis: A Comparative Analysis According to Health-Related Quality of Life, Pulmonary Function, Back Pain and Sexual Function. Children, 10.","DOI":"10.3390\/children10020299"},{"key":"ref_45","doi-asserted-by":"crossref","first-page":"400","DOI":"10.1016\/j.jspd.2016.08.002","article-title":"MRIs Are Less Accurate Tools for the Most Critically Worrisome Pedicles Compared to CT Scans","volume":"4","author":"Sarwahi","year":"2016","journal-title":"Spine Deform."},{"key":"ref_46","doi-asserted-by":"crossref","first-page":"671","DOI":"10.14444\/7098","article-title":"Comparison of Preoperative Pedicle Screw Measurement Between Computed Tomography and Magnet Resonance Imaging","volume":"14","author":"Omar","year":"2020","journal-title":"Int. J. Spine Surg."},{"key":"ref_47","doi-asserted-by":"crossref","first-page":"1221","DOI":"10.1097\/BRS.0000000000004393","article-title":"Preoperative MRI Reliably Predicts Pedicle Dimensions on Intraoperative CT Images in Structural Main Thoracic Curves in Patients with Adolescent Idiopathic Scoliosis","volume":"47","author":"Mitchell","year":"2022","journal-title":"Spine"},{"key":"ref_48","doi-asserted-by":"crossref","first-page":"e92","DOI":"10.2106\/JBJS.M.01058","article-title":"Prevalence, distribution, and surgical relevance of abnormal pedicles in spines with adolescent idiopathic scoliosis vs. no deformity: A CT-based study","volume":"96","author":"Sarwahi","year":"2014","journal-title":"J. Bone Jt. Surg. Am."}],"container-title":["Journal of Clinical Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2077-0383\/12\/16\/5368\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T20:36:32Z","timestamp":1760128592000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2077-0383\/12\/16\/5368"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,8,18]]},"references-count":48,"journal-issue":{"issue":"16","published-online":{"date-parts":[[2023,8]]}},"alternative-id":["jcm12165368"],"URL":"https:\/\/doi.org\/10.3390\/jcm12165368","relation":{},"ISSN":["2077-0383"],"issn-type":[{"value":"2077-0383","type":"electronic"}],"subject":[],"published":{"date-parts":[[2023,8,18]]}}}