title: Hybrid fixation with sublaminar polyester bands in the treatment of neuromuscular scoliosis: a comparative analysis.
abstract: 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.
  
  
  METHODS
  Level IV: cohort study.
authors.affiliation: Department of Orthopaedics, Dayton Children's Medical Center, Dayton, OH.
authors.forename: Michael C
authors.initials: MC
authors.lastname: Albert
authors.forename: Brett C
authors.initials: BC
authors.lastname: LaFleur
mesh_terms: D000293:Adolescent; D001864:Bone Wires; D002648:Child; D015331:Cohort Studies; D057186:Comparative Effectiveness Research; D005260:Female; D005500:Follow-Up Studies; D005592:Fracture Fixation / Q000009:adverse effects / Q000295:instrumentation / Q000379:methods; D006801:Humans; D008297:Male; D009468:Neuromuscular Diseases / Q000150:complications*; D009820:Ohio; D065289:Pedicle Screws; D011091:Polyesters / Q000627:therapeutic use; D011183:Postoperative Complications / Q000000981:diagnostic imaging / Q000209:etiology; D011859:Radiography; D012189:Retrospective Studies; D012600:Scoliosis / Q000000981:diagnostic imaging / Q000209:etiology / Q000601:surgery; D013131:Spine / Q000000981:diagnostic imaging / Q000601:surgery
chemical_list: D011091:Polyesters