Sublaminar banding as an adjunct to pedicle screw-rod constructs: a review and technical note on novel hybrid constructs in spinal deformity surgery

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Sublaminar implants that encircle cortical bone are well-established adjuncts to pedicle screw-rod constructs in pediatric deformity surgery. Sublaminar bands (SLBs) in particular carry the advantage of relatively greater bone contact surface area as compared to wires and pullout loads that are independent of bone mineral density, in contrast to pedicle screws. Whereas the relevant technical considerations have been reported for pediatric deformity correction, an understanding of the relative procedural specifics of these techniques is missing for adult spinal deformity (ASD), despite several case series that have used distinct posterior tethering techniques for proximal junctional kyphosis prevention. In this paper, the authors summarize the relevant literature and describe a novel technique wherein bilateral tensioned SLBs are introduced at the nonfused proximal junctional level of long-segment ASD constructs.

ABBREVIATIONS ASD = adult spinal deformity; PJCA = proximal junctional Cobb angle; PJF = proximal junctional failure; PJK = proximal junctional kyphosis; SLB = sublaminar band; UIV = upper instrumented vertebra.

Article Information

Correspondence H. Francis Farhadi: The Ohio State University Wexner Medical Center, Columbus, OH. francis.farhadi@osumc.edu.

INCLUDE WHEN CITING Published online March 1, 2019; DOI: 10.3171/2018.11.SPINE181154.

Disclosures Investigator-initiated trial support was received from DePuy Synthes, Implanet America, and Nexxt Spine. Dr. Viljoen has received a speaking honorarium from DePuy.

© AANS, except where prohibited by US copyright law.

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Figures

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    A: Drilling of bilateral hemilaminotomies is performed at the superior and inferior borders of the proximal junctional hemilamina while ensuring that the maximum bone height is available for anchoring of the bands. The inset shows an enlarged view of the drilling and hemilaminotomies. B: The ligamentum flavum is bluntly dissected off the lamina undersurface. C: The bent SLB tips are sequentially introduced by hand on the ipsilateral sides to be retrieved at the superior hemilaminotomy windows. D: Finally, the SLBs are anchored to the rods and tensioned with a ratchet. Reproduced with the permission of The Ohio State University.

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    A and B: Case 1. A 56-year-old woman with refractory back and leg pain. Spinal radiographs showed a levoscoliotic deformity of 25° and unstable spondylolisthesis of L5–S1. Her preoperative PJCA, sagittal vertical axis (SVA) deviation, sacral slope, pelvic tilt, and pelvic incidence were 8.2°, 0.5 cm, 10.0°, 29.6°, and 39.6°, respectively (A). She underwent T10–ilium fusion supplemented with SLBs inserted at T9. The immediate postoperative PJCA and SVA were 8.8° and 1.1 cm (not shown), and the PJCA and SVA at 2-year follow-up were 6.0° and 0.3 cm, respectively (B). C and D: Case 2. A 69-year-old woman with a history of multiple lumbar spinal surgeries, refractory back and right leg pain, and difficulty with horizontal gaze. Spinal radiographs revealed posterior fusion implants spanning L1–5; compression fractures at T11, T12, L1, and L2 with PJF; and severe kyphotic deformity (71°) at the thoracolumbar junction. Her preoperative PJCA, SVA deviation, sacral slope, pelvic tilt, and pelvic incidence were 2.1°, 20 cm, 31°, 31.1°, and 62.1°, respectively (C). She underwent T3–ilium fusion supplemented with SLBs inserted at T2. The immediate postoperative PJCA and SVA were 11.1° and 2.9 cm (not shown), and the PJCA and SVA at 2-year follow-up were 11.2° and 2.4 cm, respectively (D).

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