Use of subtransverse process polyester bands in pediatric spine surgery: a case series of 4 patients with a minimum of 12 months’ follow-up

Full access

OBJECT

In a previous study, the authors reported on their experience with the use of sublaminar polyester bands as part of segmental spinal constructs. However, the risk of neurological complications with sublaminar passage of instrumentation, such as spinal cord injury, limits the use of this technique. The present study reports the novel use of subtransverse process polyester bands in posterior instrumented spinal fusions of the thoracic and lumbar spines and sacrum or ilium in 4 patients.

METHODS

The authors retrospectively reviewed the demographic and procedural data of patients who had undergone posterior instrumented fusion using subtransverse process polyester bands.

RESULTS

Four patients, ranging in age from 11 to 22 years, underwent posterior instrumented fusion for neuromuscular scoliosis (3 patients) and thoracic hyperkyphosis (1 patient). There were 3 instances of transverse process fracture, with application and tensioning of the polyester band in 1 patient. Importantly, there was no instance of spinal cord injury with subtransverse process passage of the polyester band. The lessons learned from this technique are discussed.

CONCLUSIONS

This study has shown the “Eleghia” technique of passing subtransverse process bands to be a technically straightforward and neurologically safe method of spinal fixation. Pedicle screws, laminar/pedicle/transverse process hooks, and sublaminar metal wires/bands have been incorporated into posterior spinal constructs; they have been widely reported and used in the thoracic and lumbar spines and sacrum or ilium with varying success. This report demonstrates the promising results of hybrid posterior spinal constructs that include the Eleghia technique of passing subtransverse process polyester bands. This technique incorporates technical ease with minimal risk of neurological injury and biomechanical stability.

ABBREVIATIONSMEP = motor evoked potential; SSEP = somatosensory evoked potential.

Abstract

OBJECT

In a previous study, the authors reported on their experience with the use of sublaminar polyester bands as part of segmental spinal constructs. However, the risk of neurological complications with sublaminar passage of instrumentation, such as spinal cord injury, limits the use of this technique. The present study reports the novel use of subtransverse process polyester bands in posterior instrumented spinal fusions of the thoracic and lumbar spines and sacrum or ilium in 4 patients.

METHODS

The authors retrospectively reviewed the demographic and procedural data of patients who had undergone posterior instrumented fusion using subtransverse process polyester bands.

RESULTS

Four patients, ranging in age from 11 to 22 years, underwent posterior instrumented fusion for neuromuscular scoliosis (3 patients) and thoracic hyperkyphosis (1 patient). There were 3 instances of transverse process fracture, with application and tensioning of the polyester band in 1 patient. Importantly, there was no instance of spinal cord injury with subtransverse process passage of the polyester band. The lessons learned from this technique are discussed.

CONCLUSIONS

This study has shown the “Eleghia” technique of passing subtransverse process bands to be a technically straightforward and neurologically safe method of spinal fixation. Pedicle screws, laminar/pedicle/transverse process hooks, and sublaminar metal wires/bands have been incorporated into posterior spinal constructs; they have been widely reported and used in the thoracic and lumbar spines and sacrum or ilium with varying success. This report demonstrates the promising results of hybrid posterior spinal constructs that include the Eleghia technique of passing subtransverse process polyester bands. This technique incorporates technical ease with minimal risk of neurological injury and biomechanical stability.

Laminar hooks, pedicle screws, and sublaminar wires made of stainless steel, titanium alloys, or cobalt chromium alloys have been used to varying degrees of success as anchors, or fixation points, in the instrumented fusion of the pediatric spine. There are strengths and weaknesses to each of these modalities of fixation to bone. The ideal device should meld the technical ease of sublaminar wires, the adaptability of hooks, and the biomechanical stability of screws, while remaining neurologically safe.

Apical sublaminar wires and pedicle screw instrumentation offer similar outcomes in terms of degree of deformity correction.3 When compared with sublaminar wire/hook constructs and hybrid wire/hook/screw constructs, an all-pedicle-screw construct did not have a significant advantage for enhancement of deformity correction.22 In weak or skeletally immature bone, laminar hooks demonstrated a better pull-out profile than pedicle screws5; moreover, not all patients are anatomically suited for hook or pedicle-screw implantation. Therefore, no one construct type has been shown to be superior to others.

We previously reported on the successful treatment of pediatric patients who had undergone posterior instrumented fusion with hybrid hook/screw/sublaminar polyester-band constructs.7 However, unacceptable neurological morbidity, such as spinal cord injury, limits the use of sublaminar instrumentation, including the polyester band.2,4,6,13,20,24

An alternative technique is subtransverse process passage of the spinal instrumentation, such as metal wires14 and polyester bands, which seems to be a technically straightforward and neurologically safe method. In this study, our aim was to demonstrate the advantages of subtransverse process polyester bands over sublaminar polyester bands. Biomechanical and clinical studies in the literature that compare different types of sublaminar wiring and subtransverse process wiring exist.1,8,9 However, to the best of our knowledge, no prior studies have described the “Eleghia” technique of subtransverse process passage of polyester bands for spinal fixation.

Methods

Patient Population

We retrospectively reviewed the records of 4 consecutive patients who were taken to the operating room for posterior instrumented spinal fusions by the neuro-spine service at Texas Children’s Hospital between January and April 2014 (Table 1). Preoperative radiographs, CT scans, and MR images were obtained in all patients. Postoperative radiographs and CT scans of the spine were obtained in all patients at a minimum of 12 months of follow-up.

TABLE 1.

Summary of demographic and procedural data in 4 pediatric patients with hybrid spinal constructs using subtransverse process polyester bands

Pt No.Age (yrs), SexEtiologyOpAnchorsLength of Op (hrs)EBL (ml)ComplicationsFU (mos)
111, FThoracic hyperkyphosisT2–L1 pst instrumented fusionSublaminar hooks: T-2, T-3; subtransverse bands: T-4, T-8, T-9, T-10; pedicle screws: T-11, T-12, L-19.5500None16
218, MNeuromuscular scoliosisT2—ilium pst instrumented fusionSublaminar hooks: T-2, T-3; subtransverse bands: T4–10; pedicle screws: T-11, T-12, L-1; iliac screws8700T10–12 rt transverse process fracture15
312, FNeuromuscular scoliosisC2-ilium pst instrumented fusionPars screws: C-2; lat mass screws: C3–6; subtransverse bands: T1–12; iliac screws9450None12
422, FNeuromuscular scoliosisT2-ilium instrumented fusionSublaminar hooks: T-2, T-3; subtransverse bands: T4–10; sublaminar bands: T-11, T-12, L-1, L-4, L-5; iliac screws101200None12

EBL = estimated blood loss; FU = follow-up; pst = posterior; Pt = patient.

Surgical Technique

All patients were placed in the prone position after intubation. Older patients (age 8 years or older) were placed on a Jackson operating table (Orthopedic Systems Inc.), whereas younger patients (age less than 8 years) were placed on a standard operating room table, with chest bolsters and a foam pillow. Neurophysiological monitoring was used for all cases; baseline parameters for motor evoked potentials (MEPs) and somatosensory evoked potentials (SSEPs) for the lower extremities were recorded prior to skin incision. The posterior thoracic and lumbar spines and sacrum or ilium were exposed in the usual manner. Entry points for pedicle screws were prepared. Pedicle screws and laminar hooks (Legacy, Medtronic Sofamor Danek) were implanted in the usual way.

Polyester bands (Universal Clamp, Zimmer Inc.) were used bilaterally in the thoracic spine (T1–12) via the Eleghia technique. The malleable metal end of the polyester band was shaped into a gentle curve for passage between the transverse process and the rib head (Fig. 1). The polyester band was placed under the transverse process by passing near the lateral end of the transverse process in the costovertebral junction. The tip of the band then was gripped with hemostats or forceps, and the rest of the passage followed a push-pull technique, drawing through the middle part between the transverse process and the rib head. The band should rest at the confluence of the transverse process, pedicle, lamina, and superior articulating process. If a transverse process was not strong enough to hold the polyester band (usually below T-10), then the level was omitted from the construct.

FIG. 1.
FIG. 1.

Artist’s illustration demonstrating the Eleghia technique of passage of a subtransverse process polyester band. Copyright Katherine Relyea. Published with permission.

Sublaminar polyester bands were placed caudal to the level of the conus to L-5. There is a smaller risk of neurological injury in this region below the conus with sublaminar instrumentation.

Osteotomies, as required by the particular case and spinal deformity, were performed prior to securing the 5.5-mm-diameter titanium rods to the laminar hooks and pedicle screws. The subtransverse process polyester band was attached to the contralateral rod with a titanium alloy clamp and locking screw (Fig. 2). The sublaminar polyester band was attached to the ipsilateral rod. Reduction ma neuvers starting at the apex on the concave side were performed by the sequential tightening of each band/clamp implant against the transverse process or lamina and rod with a tensioner supplied by the manufacturer. The tensioner has a ratchet-driven, spring-loaded shaft that puts tension on the polyester band. The band is formed into a loop and placed onto a stump on the reduction tool. The handle is pressed against the shaft, which ratchets up the distal portion of the cylinder and progressively sets the band tension. A scale on the side of the tensioner displays the polyester band tension. A torque of 6–12 inch-pounds is usually achieved, which is sufficient to attain reduction and stabilization.

FIG. 2.
FIG. 2.

Intraoperative photograph showing the final configuration of the crossing subtransverse process polyester attached to rods. Figure is available in color online only.

Arthrodesis was performed with local autograft, morselized cancellous allograft, and bone morphogenetic protein in all cases (Infuse, Medtronic Sofamor Danek) after proper decortication. No bone harvest from other sites was performed.

This study received approval from the Baylor College of Medicine institutional review board.

Illustrative Case

History and Examination

Neurosurgery was consulted for a 12-year-old girl with a significant medical history of perinatal hypoxia-isch-emia, static encephalopathy, global developmental delay, spasticity, and seizure disorder, who was found to have progressive neuromuscular scoliosis. The patient had previously undergone surgery for vagus nerve stimulator and baclofen pump placement to address her intractable epilepsy and spasticity, respectively. Radiographs showed an S-shaped curve, with the thoracic curve toward the right with a Cobb angle of 75° and the lumbar curve toward the left with a Cobb angle of 86°. There was also a profound thoracic kyphosis with a Cobb angle of 106° (Fig. 3). Neurological examination demonstrated severe developmental delay. The patient was awake and alert, with limited interaction secondary to her developmental delay. She could occasionally vocalize but produced no recognizable words. She used a communication board for simple commands. The patient was nonambulatory and wheelchair bound but was able to reach with her right hand and exhibited a poor grasp.

FIG. 3.
FIG. 3.

Case 3. A–B: Upright preoperative anteroposterior (AP) scoliosis (A) radiograph and upright preoperative lateral scoliosis radiograph (B) demonstrating a 75° thoracic curvature, 86° lumbar curvature, and 106° thoracic kyphosis. C–D: Upright postoperative AP scoliosis radiograph (C) and upright postoperative lateral scoliosis radiograph (D) obtained 12 months after surgery showing modest improvement and reduction of the scoliosis (43° thoracic curvature and 73° lumbar curvature) and kyphosis (86° thoracic kyphosis). E: Parasagittal CT scan of the spine obtained 12 months after surgery demonstrating solid bony fusion.

No abnormalities were seen on CT, and MRI showed no abnormalities in the spinal cord. It was noted on preoperative CT scans that, although the transverse processes at T-10, T-11, and T-12 seemed to be smaller than thoracic transverse processes at more proximal levels, they appeared to be of sufficient size to accept placement of a polyester band. Furthermore, the baclofen pump catheter entered the thecal sac at the L3–4 interlaminar space. On preoperative MRI, the conus was positioned between the L-1 and L-2 levels. Therefore, after careful study of the preoperative imaging, we planned to place sublaminar bands at L-2 and L-5, below the level of the conus and avoiding the laminae (L-3 and L-4) adjacent to the baclofen pump catheter. Because of the patient’s poor head and neck control and the subsequent high risk of proximal junction kyphosis if the spinal construct was prematurely stopped in the upper thoracic spine, the surgical plan called for a C2-ilium posterior instrumented fusion to stabilize and reduce her spinal deformity.

Operation

After proper identification procedures, the patient was positioned, given general anesthesia, and intubated. Somatosensory evoked responses and motor evoked responses were measured via needle electrodes placed in the upper and lower extremities. Baseline electrophysiological parameters were recorded; there were no reproducible signals from the lower extremities.

Exposure of bone of the posterior elements of the spinal column from C-2 to the ilium was achieved. Bilateral iliac screws were placed with fluoroscopy guidance. Laminotomies were created at L1–2, L2–3, L4–5, and L5–S1 for passage of sublaminar polyester bands. The L3–4 interlaminar space, where the baclofen pump catheter entered the thecal space, was avoided to prevent inadvertent dislodgement or injury to the catheter.

The space between the transverse process and rib head at each thoracic level was then developed with a curved instrument, such as a hook starter. Care was taken to avoid fracturing the transverse process and losing a segmental point of fixation by creating an intraosseous defect with the hook starter. Subtransverse process bands were passed from caudal to rostral around the thoracic transverse processes.

C-2 pars screws and C-3, C-4, C-5, and C-6 lateral mass screws were placed bilaterally. The cervical screws were connected with a contoured 3.5-mm-diameter rod on each side, and the thoracic, lumbar, and iliac points of fixation were connected with a contoured 5.5-mm-diameter rod on each side. The adjacent 3.5- and 5.5-mm-diameter rods were secured together with a domino connector. Two cross-links were installed to create a rigid frame and countertraction against which tensioning of the polyester bands could be performed. This configuration of the spinal instrumentation allowed us to translate the curved spine toward the relatively straighter rods and effect a reduction of the spinal deformity. All connections were final tightened. Excess polyester band was truncated, leaving approximately 1 cm of material from the clamp/rod interface.

Bone graft material was placed over the exposed decorticated bone surfaces from C-2 to the ilium. Local autograft was harvested from the spinous processes from T-1 to L-5. This was supplemented with bone morphogenetic protein and 60 ml of morselized allograft mixed with demineralized bone matrix putty. Vancomycin powder and irrigation was used during closure, and a Hemovac drain was placed.

Postoperative Course

The patient had an unremarkable hospital course and was discharged 6 days after surgery. At 12 months after surgery, the patient continued to do well. There had been no change in neurological status. The parents had been pleased with her new posture and sitting balance. CT scan of the spine at 1 year after surgery demonstrated solid bony fusion with no evidence of loss of spinal alignment nor instrumentation failure (Figs. 3C–E).

Results

All 4 patients underwent operative treatment. No long-term complications have arisen in any of these 4 patients, and postoperative stability and alignment were maintained in long-term follow-up (mean 13.8 months, range 12–16 months). All patients underwent postoperative imaging during the follow-up period, consisting of spine radiographs and CT scans. There was no evidence of pseudarthrosis, instability, or hardware failure in any patient during follow-up, and fusion was achieved in these cases (Fig. 3).

Sixty polyester bands in 4 patients were passed around transverse processes. There were 3 instances of transverse process fracture in 1 patient with passage of the polyester band or overzealous tensioning of the polyester band against bone. These fractures occurred at or below T-10: at T-10 (1 fracture), T-11 (1 fracture), and T-12 (1 fracture).

Discussion

Polyester Bands

Sublaminar polyester bands, with a locking mechanism to provide rod coupling, were developed as an alternative to traditional anchors: wires, hooks, and screws.7,15,16 The material properties of polyester are characterized by its high tensile strength; high resistance to stretch, wet or dry; and resistance to degradation.19 Polyester is biocompatible without an exorbitant inflammatory reaction in surrounding tissue, including the dura. In Europe, polyester has been in use for more than 25 years in spinal implants (K. Mazda, personal communication, 2014). Abbot Spine (now Zimmer Inc.) developed the first modern interspinous device, the Wallis system, in 1986; it was in widespread use in Europe before interspinous spacers became popular in the United States. This device was used primarily for patients with recurrent disc herniation and was composed of a titanium spacer placed between spinous processes and secured with 2 polyester bands wrapped around the spinous processes.10

Polyester’s woven fabric makes it gentle, and flexible polyester bands are an excellent alternative to implantation into the pediatric spine. This is most applicable when the anatomy either is too extraordinarily small to accept hooks or screws or is marked by significant congenital structural abnormalities. The polyester bands and locking mechanism to the rod may be placed at multiple levels, similar to wires, hooks, and screws, to effect segmental control, reduction, and fusion.

Biomechanical studies11,12 have compared the pull-out strength of the sublaminar polyester banding with sublaminar wiring, laminar hooks, interspinous spacers, and pedicle screws. The mean failure load of the pedicle screw group was significantly higher than that of the sublaminar banding, sublaminar wiring, laminar hooks, and interspinous spacers. Only the pedicle screw had a statistically higher failure load than the sublaminar polyester band technique. Therefore, sublaminar polyester banding compared favorably to the traditional methods of sublaminar wires and laminar hooks and, thus, should be considered as an alternative anchor in the spine.

Nevertheless, high risk of neurological injuries limits the use of this technique—even a single case of neurological injury from sublaminar instrumentation is one too many. Neurological complications may occur intraoperatively during passage of the sublaminar polyester band or postoperatively because of spinal cord edema, peridural fibrosis, and epidural hematoma caused by disruption of the epidural venous plexus; the complications rate is 1%–15%.1,2,13,24 Thompson et al. found more neurological injuries than expected in their series of patients with sublaminar wiring methods, and, reportedly, the main reason was inexperience.21 Many intraoperative complications have been seen with the use of sublaminar wires, including dural laceration, CSF leak, and epidural, subdural, or intramedullary hemorrhage.1 Peridural fibrosis, migration secondary to wire breakage, and difficulties in removing sublaminar wires due to epidural scarring and fibrosis under the lamina are examples of reported postoperative complications.1 Transient dysesthesia syndrome was reported as a frequent complication in the postoperative period for patients who had undergone sublaminar wiring.1,18 This complication has also been documented in our series of sublaminar polyester-band patients, as seen in our case illustration and our previous report.7 Reames et al. found that anterior screw and wire-only constructs were associated with significantly higher rates of new neurological injury, as compared with pedicle screw-only and hook-only constructs.17

The Eleghia Technique

Because of the high risk of neurological complications with use of the sublaminar polyester band technique, we studied an alternative method for segmental spinal instrumentation—the Eleghia technique—for subtransverse process polyester bands. The Eleghia technique was named after a patient who changed the way we approach spine surgery. In this index case, our 14-year-old patient with cerebral palsy and progressive neuromuscular scoliosis had undergone a hybrid spinal construct from T-3 to the ilium to reduce and stabilize her spinal deformity. During passage of a sublaminar polyester band at T-11, there was a loss of intraoperative electrophysiological potentials. The surgery was aborted when there was no return in MEP and SSEP. Immediately after surgery, the patient demonstrated clonus, hyperreflexia, and lack of movement or grimace in response to painful stimuli in the bilateral lower extremities.

In our case series, we present 4 surgical cases that used the Eleghia technique (Table 1). The patient in Case 1 underwent a T2–L1 posterior instrumented fusion with subtransverse process bands at T-4 and T8–10 for thoracic hyperkyphosis. At 16 months’ follow-up, the patient was grossly neurologically intact without back or neck pain, leg weakness, or bowel or bladder dysfunction. The patient in Case 2 underwent T2-ilium posterior instrumented fusion with subtransverse process bands at T4–10 for neuromuscular scoliosis. During the operation, right T-10 through T-12 transverse processes fractures occurred due to osteoporosis and the small size of these transverse processes, which are typically seen at the caudal end of the thoracic spine. At 15 months’ follow-up, he was grossly at his neurological baseline. The patient in Case 3 underwent C-2-ilium posterior instrumented fusion for neuromuscular scoliosis with subtransverse process bands at T1–12. At 12 months’ follow-up, she was grossly at her neurological baseline without any complaints. The patient in Case 4 underwent T2-ilium instrumented fusion for neuromuscular scoliosis with transverse bands at T4–10. At 12 months’ follow-up, she was grossly at her neurological baseline without any complaints.

In a study by Wenger et al.,23 the strength of fixation points in the instrumented vertebrae was examined, and they found that resistance to failure was greatest in intact lamina, followed by decorticated lamina, the transverse process, and the spinous process. Kemal Us et al.14 reported no neurological complications in the early results of scoliotic patients treated with the subtransverse process wiring method. Akmeşe and Kemal Us showed similar results in a cohort of patients with main thoracic adolescent idiopathic scoliosis who were operated on using a subtransverse process wiring technique.1 Overall, the evidence suggests that subtransverse process wiring is a safe technique, and we adapted this technique to use with polyester bands. Transverse processes are not only stronger than spinous processes, but also safer than operating in the sublaminar space.

Lessons Learned

Care must be taken not to overtighten the bands, which can cause the bands to pull through or fracture a weak or skeletally immature lamina, as occurred in one of our cases. Aggressive decortication in preparing the bony bed for arthrodesis, likewise, may decrease transverse process strength and increase the risk of transverse process fracture in the follow-up period.

The ligamentous structures between the rib head and transverse process may pose a unique challenge to the neurosurgeon during passage of the wire. The use of a curved starting instrument may help disrupt the costotransverse ligament, making passage of the subtransverse process easier. Because the space between the transverse process and rib head is devoid of critical neurovascular structures, the bands can be drawn through by applying more force than what would be acceptable for sublaminar passage.

Conclusions

Subtransverse process passage of polyester bands is biomechanically sound, resulting in maintenance of postoperative spinal alignment and the development of bony fusion. Because subtransverse process polyester bands are located away from the spinal canal, this technique may be safer and more technically straightforward than traditional methods of fixation. More follow-up studies with a greater number of patients are needed to determine long-term safety and efficacy, as well as the effects and outcomes in the maintenance of deformity correction of posterior spinal fusions with hybrid hook/screw/subtransverse process polyester band constructs in pediatric spinal deformities.

Posterior instrumented spinal fusions in patients with small or abnormal anatomy from congenital or acquired deformities represent technically challenging cases. Placement of pedicle screws in these patients is difficult, even in the best of hands. Sublaminar instrumentation carries an unacceptably high risk of spinal cord injury. A direct comparison of outcomes between sublaminar and subtransverse process cohorts may prove helpful.

Author Contributions

Conception and design: Jea. Acquisition of data: Sayama, Bri-ceño. Analysis and interpretation of data: Sayama, Briceño. Drafting the article: Jea, Strickland. Critically revising the article: Jea, Lam, Luerssen. Reviewed submitted version of manuscript: Jea. Administrative/technical/material support: Luerssen. Study supervision: Jea.

References

  • 1

    Akmeşe RKemal Us A: Comparison of subtransverse process wiring and sublaminar wiring in the treatment of idiopathic thoracic scoliosis. J Spinal Disord Tech 26:79862013

  • 2

    Bridwell KH: Spinal instrumentation in the management of adolescent scoliosis. Clin Orthop Relat Res 335:64721997

  • 3

    Cheng IKim YGupta MCBridwell KHHurford RKLee SS: Apical sublaminar wires versus pedicle screws— which provides better results for surgical correction of adolescent idiopathic scoliosis?. Spine (Phila Pa 1976) 30:210421122005

  • 4

    Christodoulou AGKapetanos GApostolou TPournaras JSymeonides PP: Segmental spinal correction of idiopathic scoliosis. Luque rods and Hartshill rectangle in 30 patients followed for 2–6 years. Acta Orthop Scand Suppl 275:371997

  • 5

    Cordista AConrad BHorodyski MWalters SRechtine G: Biomechanical evaluation of pedicle screws versus pedicle and laminar hooks in the thoracic spine. Spine J 6:4444492006

  • 6

    Dove J: Segmental wiring for spinal deformity. A morbidity report. Spine (Phila Pa 1976) 14:2292311989

  • 7

    Fahim DKWhitehead WECurry DJDauser RCLuerssen TGJea A: Routine use of recombinant human bone morphogenetic protein-2 in posterior fusions of the pediatric spine: safety profile and efficacy in the early postoperative period. Neurosurgery 67:119512042010

  • 8

    Fujita MDiab MXu ZPuttlitz CM: A biomechanical analysis of sublaminar and subtransverse process fixation using metal wires and polyethylene cables. Spine (Phila Pa 1976) 31:220222082006

  • 9

    Gadgil AAhmed EBRahmatalla ADove JMaffulli N: A study of the mechanical stability of scoliosis constructs using variable numbers of sublaminar wires. Eur Spine J 11:3213262002

  • 10

    Gazzeri RGalarza MAlfieri A: Controversies about interspinous process devices in the treatment of degenerative lumbar spine diseases: past, present, and future. BioMed Res Int 2014:9750522014

  • 11

    Hongo MIlharreborde BGay REZhao CZhao KDBerglund LJ: Biomechanical evaluation of a new fixation device for the thoracic spine. Eur Spine J 18:121312192009

  • 12

    Ilharreborde BShaw MNBerglund LJZhao KDGay REAn KN: Biomechanical evaluation of posterior lumbar dynamic stabilization: an in vitro comparison between Universal Clamp and Wallis systems. Eur Spine J 20:2892962011

  • 13

    Johnston CE IIHappel LT JrNorris RBurke SWKing AGRoberts JM: Delayed paraplegia complicating sublaminar segmental spinal instrumentation. J Bone Joint Surg Am 68:5565631986

  • 14

    Kemal Us AYilmaz CAltay MYavuz OYSinan Bilgin S: Subtransverse process wiring: a new technique of segmental spinal fixation of the thoracic spine or in the treatment of adolescent idiopathic scoliosis. Spine (Phila Pa 1976) 26:239223962001

  • 15

    La Rosa GGiglio GOggiano L: Surgical treatment of neurological scoliosis using hybrid construct (lumbar transpedicular screws plus thoracic sublaminar acrylic loops). Eur Spine J 20:Suppl 1S90S942011

  • 16

    Mazda KIlharreborde BEven JLefevre YFitoussi FPen-neçot GF: Efficacy and safety of posteromedial translation for correction of thoracic curves in adolescent idiopathic scoliosis using a new connection to the spine: the Universal Clamp. Eur Spine J 18:1581692009

  • 17

    Reames DLSmith JSFu KMPolly DW JrAmes CPBerven SH: Complications in the surgical treatment of 19,360 cases of pediatric scoliosis: a review of the Scoliosis Research Society Morbidity and Mortality database. Spine (Phila Pa 1976) 36:148414912011

  • 18

    Segal LSSchwentker EP: Wire-holding frame for sublaminar segmental spinal instrumentation. Spine (Phila Pa 1976) 19:119011921994

  • 19

    Seitz HMarlovits SSchwendenwein IMüller EVécsei V: Biocompatibility of polyethylene terephthalate (Trevira hochfest) augmentation device in repair of the anterior cruciate ligament. Biomaterials 19:1891961998

  • 20

    Thometz JGEmans JB: A comparison between spinous process and sublaminar wiring combined with Harrington distraction instrumentation in the management of adolescent idiopathic scoliosis. J Pediatr Orthop 8:1291321988

  • 21

    Thompson GHWilber RGShaffer JWScoles PVKalamchi ANash CL Jr: Segmental spinal instrumentation in idiopathic spinal deformities. Orthop Trans 9:1231241985

  • 22

    Vora VCrawford ABabekhir NBoachie-Adjei OLenke LPeskin M: A pedicle screw construct gives an enhanced posterior correction of adolescent idiopathic scoliosis when compared with other constructs: myth or reality. Spine (Phila Pa 1976) 32:186918742007

  • 23

    Wenger DMiller SWilkerson J: Evaluation of fixation sites for segmental instrumentation of the human vertebrae. Orthop Trans 6:23241982

  • 24

    Wilber RGThompson GHShaffer JWBrown RHNash CL Jr: Postoperative neurological deficits in segmental spinal instrumentation. A study using spinal cord monitoring. J Bone Joint Surg Am 66:117811871984

If the inline PDF is not rendering correctly, you can download the PDF file here.

Article Information

Correspondence Andrew Jea, Division of Pediatric Neurosurgery, Texas Children’s Hospital, 6621 Fannin St., CCC 1230.01, 12th Fl., Houston, TX 77030. email: ahjea@texaschildrens.org.

INCLUDE WHEN CITING Published online October 30, 2015; DOI: 10.3171/2015.6.PEDS15255.

Disclosure The authors report no conflicts of interest concerning the materials or methods used in this study or the findings specified in this paper.

© AANS, except where prohibited by US copyright law.

Headings

Figures

  • View in gallery

    Artist’s illustration demonstrating the Eleghia technique of passage of a subtransverse process polyester band. Copyright Katherine Relyea. Published with permission.

  • View in gallery

    Intraoperative photograph showing the final configuration of the crossing subtransverse process polyester attached to rods. Figure is available in color online only.

  • View in gallery

    Case 3. A–B: Upright preoperative anteroposterior (AP) scoliosis (A) radiograph and upright preoperative lateral scoliosis radiograph (B) demonstrating a 75° thoracic curvature, 86° lumbar curvature, and 106° thoracic kyphosis. C–D: Upright postoperative AP scoliosis radiograph (C) and upright postoperative lateral scoliosis radiograph (D) obtained 12 months after surgery showing modest improvement and reduction of the scoliosis (43° thoracic curvature and 73° lumbar curvature) and kyphosis (86° thoracic kyphosis). E: Parasagittal CT scan of the spine obtained 12 months after surgery demonstrating solid bony fusion.

References

1

Akmeşe RKemal Us A: Comparison of subtransverse process wiring and sublaminar wiring in the treatment of idiopathic thoracic scoliosis. J Spinal Disord Tech 26:79862013

2

Bridwell KH: Spinal instrumentation in the management of adolescent scoliosis. Clin Orthop Relat Res 335:64721997

3

Cheng IKim YGupta MCBridwell KHHurford RKLee SS: Apical sublaminar wires versus pedicle screws— which provides better results for surgical correction of adolescent idiopathic scoliosis?. Spine (Phila Pa 1976) 30:210421122005

4

Christodoulou AGKapetanos GApostolou TPournaras JSymeonides PP: Segmental spinal correction of idiopathic scoliosis. Luque rods and Hartshill rectangle in 30 patients followed for 2–6 years. Acta Orthop Scand Suppl 275:371997

5

Cordista AConrad BHorodyski MWalters SRechtine G: Biomechanical evaluation of pedicle screws versus pedicle and laminar hooks in the thoracic spine. Spine J 6:4444492006

6

Dove J: Segmental wiring for spinal deformity. A morbidity report. Spine (Phila Pa 1976) 14:2292311989

7

Fahim DKWhitehead WECurry DJDauser RCLuerssen TGJea A: Routine use of recombinant human bone morphogenetic protein-2 in posterior fusions of the pediatric spine: safety profile and efficacy in the early postoperative period. Neurosurgery 67:119512042010

8

Fujita MDiab MXu ZPuttlitz CM: A biomechanical analysis of sublaminar and subtransverse process fixation using metal wires and polyethylene cables. Spine (Phila Pa 1976) 31:220222082006

9

Gadgil AAhmed EBRahmatalla ADove JMaffulli N: A study of the mechanical stability of scoliosis constructs using variable numbers of sublaminar wires. Eur Spine J 11:3213262002

10

Gazzeri RGalarza MAlfieri A: Controversies about interspinous process devices in the treatment of degenerative lumbar spine diseases: past, present, and future. BioMed Res Int 2014:9750522014

11

Hongo MIlharreborde BGay REZhao CZhao KDBerglund LJ: Biomechanical evaluation of a new fixation device for the thoracic spine. Eur Spine J 18:121312192009

12

Ilharreborde BShaw MNBerglund LJZhao KDGay REAn KN: Biomechanical evaluation of posterior lumbar dynamic stabilization: an in vitro comparison between Universal Clamp and Wallis systems. Eur Spine J 20:2892962011

13

Johnston CE IIHappel LT JrNorris RBurke SWKing AGRoberts JM: Delayed paraplegia complicating sublaminar segmental spinal instrumentation. J Bone Joint Surg Am 68:5565631986

14

Kemal Us AYilmaz CAltay MYavuz OYSinan Bilgin S: Subtransverse process wiring: a new technique of segmental spinal fixation of the thoracic spine or in the treatment of adolescent idiopathic scoliosis. Spine (Phila Pa 1976) 26:239223962001

15

La Rosa GGiglio GOggiano L: Surgical treatment of neurological scoliosis using hybrid construct (lumbar transpedicular screws plus thoracic sublaminar acrylic loops). Eur Spine J 20:Suppl 1S90S942011

16

Mazda KIlharreborde BEven JLefevre YFitoussi FPen-neçot GF: Efficacy and safety of posteromedial translation for correction of thoracic curves in adolescent idiopathic scoliosis using a new connection to the spine: the Universal Clamp. Eur Spine J 18:1581692009

17

Reames DLSmith JSFu KMPolly DW JrAmes CPBerven SH: Complications in the surgical treatment of 19,360 cases of pediatric scoliosis: a review of the Scoliosis Research Society Morbidity and Mortality database. Spine (Phila Pa 1976) 36:148414912011

18

Segal LSSchwentker EP: Wire-holding frame for sublaminar segmental spinal instrumentation. Spine (Phila Pa 1976) 19:119011921994

19

Seitz HMarlovits SSchwendenwein IMüller EVécsei V: Biocompatibility of polyethylene terephthalate (Trevira hochfest) augmentation device in repair of the anterior cruciate ligament. Biomaterials 19:1891961998

20

Thometz JGEmans JB: A comparison between spinous process and sublaminar wiring combined with Harrington distraction instrumentation in the management of adolescent idiopathic scoliosis. J Pediatr Orthop 8:1291321988

21

Thompson GHWilber RGShaffer JWScoles PVKalamchi ANash CL Jr: Segmental spinal instrumentation in idiopathic spinal deformities. Orthop Trans 9:1231241985

22

Vora VCrawford ABabekhir NBoachie-Adjei OLenke LPeskin M: A pedicle screw construct gives an enhanced posterior correction of adolescent idiopathic scoliosis when compared with other constructs: myth or reality. Spine (Phila Pa 1976) 32:186918742007

23

Wenger DMiller SWilkerson J: Evaluation of fixation sites for segmental instrumentation of the human vertebrae. Orthop Trans 6:23241982

24

Wilber RGThompson GHShaffer JWBrown RHNash CL Jr: Postoperative neurological deficits in segmental spinal instrumentation. A study using spinal cord monitoring. J Bone Joint Surg Am 66:117811871984

TrendMD

Metrics

Metrics

All Time Past Year Past 30 Days
Abstract Views 0 0 0
Full Text Views 154 154 31
PDF Downloads 223 223 30
EPUB Downloads 0 0 0

PubMed

Google Scholar