Abstract
Purpose
To compare the 2-year minimum postoperative results of posterior correction and spinal arthrodesis using translational correction with hybrid (sublaminar bands on concave side and pedicle screw) constructs versus correction with intermediate density pedicle screw-only constructs in the treatment of AIS (Lenke 1).
Methods
A total of 37 patients with AIS at single institutions who underwent posterior spinal arthrodesis pedicle screw with sublaminar bands at the apex (19 patients) (Group A) or pedicle screw-only (18) constructs (Group B) were selected and matched according to similar age at surgery 13.8 years (Group A) and 14.3 years (Group B), similar arthrodesis area 12.3 (Group A) and 11.5 (Group B), all curves Lenke type 1 with similar pre-op curve 54° (Group A) and 57° (Group B). Patients were evaluated pre-op, immediately post-op, and at min 2-year follow-up according to radiographic curve correction, operating time, intraoperative blood loss, and f.u. loss of correction.
Results
The average curve correction was 65.6% in sublaminar group and 68% in pedicle screw group. At 2-year follow-up, loss of the major curve correction was 2% in sublaminar group compared to 3% in pedicle screw group. Postoperative coronal and sagittal balance was similar in both groups. Operating time averaged 200 min (Group A) and 180 min (Group B). Intraoperative blood loss was significantly different in both groups 700 ± 160 cc in sublaminar group and 630 ± 150 cc in pedicle screw group. There were no neurologic complications in both groups.
Conclusion
The two groups offer similar curve correction without neurologic complications in the surgical treatment of AIS (Lenke 1). The use of sublaminar bands on the apex (concave side) can be a valid fixation in the presence of hypoplastic pedicle, can reduce the thoracic hypokyphosis and derotate the vertebra but had more blood loss comparing to pedicle screws alone.
Graphical abstract
These slides can be retrieved under Electronic Supplementary Material.
Similar content being viewed by others
References
Asher MA (1997) Isola spinal instrumentation system for scoliosis. In: Bridwell KH, DeWald RL (eds) The textbook of spinal surgery. Lippincott-Raven, Philadelphia, pp 596–606
Bess RS, Lenke LG, Bridwell KH, Cheh G, Mandel S, Sides B (2007) Comparison of thoracic pedicle screw to hook instrumentation for the treatment of adult spinal deformity. Spine 32:555–561. https://doi.org/10.1097/01.brs.0000256445.31653
Cheng I, Kim Y, Gupta MC, Bridwell KH, Hurford RK, Lee SS, Theerajunyaporn T, Lenke LG (2005) Apical sublaminar wires versus pedicle screws—which provides better results for surgical correction of adolescent idiopathic scoliosis? Spine 30. https://doi.org/10.1097/01.brs.0000179261.70845.b7
Cotrel Y, Dubousset J (1984) A new technique for segmental spinal osteosynthesis using the posterior approach. Rev Chir Orthop Reparatrice Appar Mot 70:489–494
Dobbs MB, Lenke LG, Kim YJ, Kamath G, Peelle MW, Bridwell KH (2006) Selective posterior thoracic fusions for adolescent idiopathic scoliosis: comparison of hooks versus pedicle screws. Spine 31. https://doi.org/10.1097/01.brs.0000240212.31241.8e
Hirch C, Ilharreborde B, Fournier J, Mazda K (2014) Adolescent idiopathic scoliosis correction archieved by posteromedial translation using polyester bands. A comparative study of subtrasverse process versus sublaminar fixation. Orthop Traumatol Surg Res 100(7):791–795
Kim YJ, Lenke LG, Bridwell KH, Kim J, Cho SK, Cheh G, Yoon J (2007) Proximal junctional kyphosis in adolescent idiopathic scoliosis after 3 different types of posterior segmental spinal instrumentation and fusions: incidence and risk factor analysis of 410 cases. Spine 32. https://doi.org/10.1097/BRS.0b013e318074c3ce
Kim YJ, Lenke LG, Cho SK, Bridwell KH, Sides B, Blanke K (2004) Comparative analysis of pedicle screw versus hook instrumentation in posterior spinal fusion of adolescent idiopathic scoliosis. Spine 29:2040–2048. https://doi.org/10.1097/01.brs.0000138268.12324.1a
Kim YJ, Lenke LG, Kim J, Bridwell KH, Cho SK, Cheh G, Sides B (2006) Comparative analysis of pedicle screw versus hybrid instrumentation in posterior spinal fusion of adolescent idiopathic scoliosis. Spine 31:291–298. https://doi.org/10.1097/01.brs.0000197865.20803.d4
Lee SM, Suk SI, Chung ER (2004) Direct vertebral rotation: a new technique of three-dimensional deformity correction with segmental pedicle screw fixation in adolescent idiopathic scoliosis. Spine 29:343–349. https://doi.org/10.1097/01.BRS.0000109991.88149.19
Lenke LG, Betz RR, Harms J, Bridwell KH, Clements DH, Lowe TG, Blanke K (2001) Adolescent idiopathic scoliosis: a new classification to determine extent of spinal arthrodesis. J Bone Joint Surg Am 83-A:1169–1181
Lowenstein JE, Matsumoto H, Vitale MG, Weidenbaum M, Gomez JA, Lee FY, Hyman JE, Roye DP (2007) Coronal and sagittal plane correction in adolescent idiopathic scoliosis: a comparison between all pedicle screw versus hybrid thoracic hook lumbar screw constructs. Spine 32:448–452. https://doi.org/10.1097/01.brs.0000255030.78293.fd
Luque ER (1982) Segmental spinal instrumentation for correction of scoliosis. Clin Orthop Relat Res 163:192–198
Mazda K, Ilharreborde B, Even J, Lefevre Y (2009) Efficacy and safety of posterolateral translation for correction of thoracic curves in adolescent idiopathic scoliosis using a new connection to the spine: universal clamp. Eur Spine J 18:158–169
Perdriolle R (1979) La scoliose. Son étude tridimensionnelle. Maloine, Paris
Perisinakis K, Theocharopoulos N, Damilakis J, Katonis P, Papadokostakis G, Hadjipavlou A, Gourtsoyiannis N (2004) Estimation of patient dose and associated radiogenic risks from fluoroscopically guided pedicle screw insertion. Spine 29:1555–1560. https://doi.org/10.1097/01.BRS.0000131214.57597.21
Remes V, Helenius I, Schlenzka D, Yrjonen T, Ylikoski M, Poussa M (2004) Cotrel–Dubousset (CD) or Universal Spine System (USS) instrumentation in adolescent idiopathic scoliosis (AIS): comparison of midterm clinical, functional, and radiologic outcomes. Spine 29:2024–2030. https://doi.org/10.1097/01.brs.0000138408.64907.dc
Senaran H, Shah SA, Gabos PG, Littleton AG, Neiss G, Guille JT (2008) Difficult thoracic pedicle screw placement in adolescent idiopathic scoliosis. J Spinal Disord Tech 21:187–191. https://doi.org/10.1097/BSD.0b013e318073cc1d
Suk SI, Lee CK, Kim WJ, Chung YJ, Park YB (1995) Segmental pedicle screw fixation in the treatment of thoracic idiopathic scoliosis. Spine 20:1399–1405. https://doi.org/10.1097/00007632-199520120-00012
Takahata M, Ito M, Abumi K, Kotani Y, Sudo H, Ohshima S, Minami A (2007) Comparison of novel ultra-high molecular weight polyethylene tape versus conventional metal wire for sublaminar segmental fixation in the treatment of adolescent idiopathic scoliosis. J Spinal Disord Tech 20:449–455. https://doi.org/10.1097/BSD.0b013e318030d30e
Upendra BN, Meena D, Chowdhury B, Ahmad A, Jayaswal A (2008) Outcome-based classification for assessment of thoracic pedicular screw placement. Spine 33:384–390. https://doi.org/10.1097/BRS.0b013e3181646ba1
Vialle R, Levassor N, Rillardon L, Templier A, Skalli W, Guigui P (2005) Radiographic analysis of the sagittal alignment and balance of the spine in asymptomatic subjects. J Bone Joint Surg Am 87:260–267. https://doi.org/10.2106/JBJS.D.02043
Vora V, Crawford A, Babekhir N, Boachie-Adjei O, Lenke L, Peskin M, Charles G, Kim Y (2007) A pedicle screw construct gives an enhanced posterior correction of adolescent idiopathic scoliosis when compared with other constructs: myth or reality. Spine 32:1869–1874. https://doi.org/10.1097/BRS.0b013e318108b912
Weiss HR (1995) Measurement of vertebral rotation: Perdriolle versus Raimondi. Eur Spine J 4:34–38. https://doi.org/10.1007/BF00298416
Winter RB, Lonstein JE, Denis F (2007) How much correction is enough? Spine 32:2641–2643
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Conflict of interest
All authors declare that they have no conflict of interest.
Electronic supplementary material
Below is the link to the electronic supplementary material.
Rights and permissions
About this article
Cite this article
Palmisani, M., Dema, E., Cervellati, S. et al. Hybrid constructs pedicle screw with apical sublaminar bands versus pedicle screws only for surgical correction of adolescent idiopathic scoliosis. Eur Spine J 27 (Suppl 2), 150–156 (2018). https://doi.org/10.1007/s00586-018-5625-x
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00586-018-5625-x