Abstract
Proximal screw pullout is a well-recognized problem in anterior scoliosis surgery, with a rate of pseudarthrosis or screw pullout ranging from 15 to 30%. To prevent screw pullout at the top of the construct, the authors have devised the concept of a claw for the top instrumented vertebra. The claw consists of a classic anterior vertebral body screw inserted parallel to the inferior end-plate and in the posterior portion of the vertebral body 8 mm in front of the spine canal. After rib desarticulation, a laminar hook of a small size is inserted over the superior aspect of the pedicle of the same vertebra. The rod is then inserted into the two side openings of the screw and the hook. Compression across the hook and the screw is then performed, making a claw construct. This concept can also be extended in the case of early revision for a proximal screw pullout, where it is possible to revise the instrumentation with an offset connector linking the rod to the superior portion of the pedicle where the suprapedicule hook has been inserted. We report two cases where a suprapedicle claw was successfully used in anterior scoliosis correction of a right thoracic curve. Such a concept may represent the solution to proximal screw pullout in anterior scoliosis correction.
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References
Aebi M, Thalgott JS, Webb JK (1998) AOASIF principles in spine surgery. Scoliosis anterior correction and stabilisation. Springer, Berlin Heidelberg New York
Alobaid A, Arlet V, Busato A, Steffen T (2005) Pullout strength of the suprapedicle claw construct. A biomechanical study. Eur Spine J (in press)
Betz RR, Shufflebarger H (2001) Anterior versus posterior instrumentation for the correction of thoracic idiopathic scoliosis. Spine 26:1095–1100
Bitan FD, Neuwirth MG, Kuflik PL, Casden A, Bloom N, Siddiqui S (2002) The use of short and rigid anterior instrumentation in the treatment of idiopathic thoracolumbar scoliosis: a retrospective review of 24 cases. Spine 27:1553–1557
Gertzbein SD, Robbins SE (1990) Accuracy of pedicular screw placement in vivo. In: Dwyer AF, Newton NC, Sherwood AA(eds) 1969 An anterior approach to scoliosis. A preliminary report. Spine 15:11–14
Kaneda K, Shono Y, Satoh S, Abumi K (1996) New anterior instrumentation for the management of thoracolumbar and lumbar scoliosis. Application of the Kaneda two-rod system. Spine 21:1250–1261
Lazorthes G, Gouaze A, Zadeh JO, et al (1971) Arterial vascularization of the spinal cord. Recent studies of the anastomotic substitution pathways. J Neurosurg 35:253–262
Lieberman IH, Khazim R, Woodside T (1998) Anterior vertebral body screw pullout testing. A comparison of Zielke, Kaneda, Universal spine system, and Universal spine system with pullout-resistant nut. Spine 23:908–910
Liljenqvist UR, Halm HF, Link TM (1997) Pedicle screw instrumentation of the thoracic spine in idiopathic scoliosis. Spine 22:2239–2245
Moe JH, Purcell GA, Bradford DS.(1983). Zielke instrumentation (VDS) for the correction of spinal curvature. Analysis of results in 66 patients. Clin Orthop 180:133–153
Papin P, Arlet V, Marchesi D, Rosenblatt B, Aebi M (1999) Unusual presentation of spinal cord compression related to misplaced pedicle screws in thoracic scoliosis. Eur Spine J 8:156–159
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Arlet, V., Shilt, J. & Ouellet, J. The suprapedicle claw construct in anterior scoliosis surgery. Eur Spine J 14, 789–794 (2005). https://doi.org/10.1007/s00586-004-0804-3
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DOI: https://doi.org/10.1007/s00586-004-0804-3