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Hybrid Circumferential Fixation for Degenerative Lumbosacral Spine Disease: Posterior Lumbar Interbody Fusion Plus Universal Clamp Rod-Band InstrumentationA Novel Technique for Lumbosacral Fixation

Tegos, Stergios MD, PhD*; Charitidis, Charalampos MD, PhDc*; Korovessis, Panagiotis G. PhD

doi: 10.1097/BRS.0000000000000210
Clinical Case Series

Study Design. Retrospective study on circumferential hybrid instrumentation with posterior lumbar interbody fusion (PLIF) and the novel posterior Universal Clamp (UC) instrumentation.

Objective. This study evaluated the roentgenographic and clinical outcome after PLIF with PEEK cage augmented with UC posterior sublaminar fixation without posterior fusion.

Summary of Background Data. Although UC has been successfully used in scoliosis surgery, to our knowledge, this is the first report on its use in degenerative lumbosacral disease. Rigid pedicle screw lumbosacral fixation is associated with several intraoperative screw-related complications. The use of sublaminar bands and rods combined with PEEK PLIF should increase fusion rate and avoid screw-related complications.

Methods. From a total of 295 consecutive patients who experienced degenerative lumbosacral disease and received posterior decompression, implantation of PLIF with PEEK cages and semirigid posterior fixation with sublaminar UC bands-rods without posterolateral fusion, 150 patients were eligible for this study with a follow-up of more than 2 years. Interbody fusion rate and global plus segmental sagittal spinal lordosis restoration were recorded pre- and postoperatively. Visual analogue scale and Oswestry Disability Index were used to assess functional outcome.

Results. Hybrid instrumentation expanded over 1 to 5 levels. Surgical time ranged from 45 to 225 minutes. Only 12.6% of the patients were transfused. There was no nerve root lesion or deep wound infection. Laminar fracture occurred intraoperatively in one case during band insertion. Interbody fusion was achieved in 94% of the operated segments. Lumbar lordosis improved from −36 ± 9° preoperatively to −53 ± 6° postoperatively. Segmental lordosis improved in L4–L5 segment from −5 ± 3° preoperatively to −12 ± 2° postoperatively and in L5–S1 from −9 ± 4° to −14 ± 2° postoperation. Oswestry Disability Index score improved from 44.9 preoperatively to 2.2 postoperatively (P < 0.001). No patient required further spinal surgery until the final evaluation.

Conclusion. UC, a novel semirigid sublaminar posterior instrumentation, combined with wedge-shaped PEEK PLIF corrected both global and segmental sagittal lumbar alignment and achieved fusion rate similar to that historically reported with pedicle screw-PLIF techniques, however, avoiding intraoperative complications associated with the use of pedicle screws.

Level of Evidence: 4

Universal Clamp, a novel sublaminar posterior instrumentation, combined with posterior lumbar interbody fusion corrected both global and segmental sagittal lumbar spinal lordosis and achieved high fusion rate that is comparable with that reported with conventional pedicle screw-posterior lumbar interbody fusion techniques avoiding intraoperative complications associated with the use of rigid pedicle screw constructs. No revision surgery was needed in any patient in this series.

*Neurosurgical Department, NIMTS Army Veterans Hospital Athens, Athens, Greece; and

Orthopedic Department General Hospital “Agios Andreas,” Patras, Greece.

Address correspondence and reprint requests to Panagiotis Korovessis, PhD, Orthopedic Department General Hospital “Agios Andreas,” 1 Tsertidou str, GR-26224 Patras, Greece; E-mail:

Acknowledgment date: July 29, 2013. First revision date: December 1, 2013. Acceptance date: January 2, 2014.

The device(s)/drug(s) is/are FDA approved or approved by corresponding national agency for this indication.

No funds were received in support of this work.

No relevant financial activities outside the submitted work.

© 2014 by Lippincott Williams & Wilkins