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Hybrid Fixation With Sublaminar Polyester Bands in the Treatment of Neuromuscular Scoliosis: A Comparative Analysis

Albert, Michael C. MD; LaFleur, Brett C. MD

Journal of Pediatric Orthopaedics: March 2015 - Volume 35 - Issue 2 - p 172–177
doi: 10.1097/BPO.0000000000000235

Background: Segmental spinal instrumentation with Luque wire fixation has been the standard treatment of neuromuscular scoliosis for >30 years. More recently, pedicle screw constructs have become the most widely utilized method of posterior spinal fixation; however, they are associated with complications such as implant malposition. We report the use of polyester bands and clamps utilized with pedicle screws in a hybrid fixation construct in the treatment of neuromuscular scoliosis.

Methods: A retrospective review was conducted of 115 pediatric spinal deformity cases between 2008 and 2010 at a single center performed by a single surgeon. Intraoperative and postoperative complications were recorded. Radiographs were reviewed preoperatively and at the latest follow-up. A systematic review of the literature was conducted. Data from case series reporting outcomes of sublaminar wires and all-pedicle screw constructs in the treatment of neuromuscular scoliosis were compared with outcomes of the present study.

Results: Twenty-nine patients with neuromuscular scoliosis who underwent segmental spinal instrumentation with a hybrid construct including sublaminar bands and pedicle screws were included. There was an average follow-up of 29 months (range, 12 to 40 mo). The average postoperative correction of coronal balance was 69% (range, 24 to 71 degrees). Sagittal balance was corrected to within 2 cm of the C7 plumbline in 97% of patients. The loss of coronal and sagittal correction at latest follow-up was 0% and 2%, respectively. There were 2 intraoperative clamp failures of the 398 implants (0.5%). There were 2 major (6.9%) and 7 minor (24%) complications in 7 patients (24% overall). These results compared favorably to previous case series of sublaminar wire and all-pedicle screw fixation techniques.

Conclusions: The polyester band technique is an excellent adjunct in the correction of spinal deformity in patients with neuromuscular scoliosis. Sublaminar bands utilized in a hybrid construct appear to be safe, can achieve corrections equivalent to all-pedicle screw constructs, and may decrease the potential complications associated with every level transpedicular fixation in the patient with a highly dysmorphic and osteoporotic spine.

Level of Evidence: Level IV: cohort study.

Department of Orthopaedics, Dayton Children’s Medical Center, Dayton, OH

M.C.A. is a paid consultant for OrthoPediatrics. The remaining author declares no conflicts of interest.

Reprints: Michael C. Albert, MD, Orthopaedic Center for Spinal and Pediatric Care, Children's Medical Center of Dayton, 1 Children's Plaza, Dayton, OH 45404. E-mail:

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