title: Adolescent idiopathic scoliosis correction achieved by posteromedial translation using polyester bands: A comparative study of subtransverse process versus sublaminar fixation.
abstract: OBJECTIVE
  Sublaminar polyester bands have been used in hybrid construct to achieve correction of adolescent idiopathic scoliosis since 2003. Despite the reported safety of the bands, some surgeons remain reluctant at the idea of approaching the canal because of the potential neurological complications reported with the Luque wiring. Sub transverse bands might be an alternative. The present study is the first to compare sublaminar polyester band fixation to fixation of polyester bands around the transverse processes in hybrid constructs used to treat AIS.
  
  
  METHODS
  Two cohorts of consecutive patients treated for thoracic AIS were retrospectively reviewed, with a minimum 2-year follow-up. Posteromedial translation was used for main curve correction in all cases. Sublaminar polyester bands were used in group 1 (20 patients). In group 2 (20 patients), the same implant was used, but the bands were passed around the transverse process instead of the lamina. Radiographic analysis included frontal Cobb angle measurements for each curve, thoracic kyphosis and rotation of the apical vertebra (RVA).
  
  
  RESULTS
  Mean operative time was similar in groups 1 and 2 (235±35 and 240±30minutes, respectively). Mean frontal correction achieved for the main curve was similar in both groups, 62.5±17.4% in group 1 and 54.1±19.4% in group 2. Sagittal correction was similar, with a final mean thoracic kyphosis of 30.9°±9.7° and 27.8°± 6.8° in group 1 and 2, respectively. Correction of RVA was similar in both groups postoperatively, 65.8% (±29.1) and 54.4% (±42.7) in group 1 and 2 respectively. No transverse process or lamina fracture was observed during insertion of the bands or curve correction in any of the groups.
  
  
  CONCLUSIONS
  This study confirms that anchorage of Universal clamps (UCs) around transverse processes is a safe and efficacious technique in both the frontal and sagittal planes, providing a useful alternative for the correction of moderate AIS. UCs attached to transverse processes can achieve correction of moderate AIS similar to that obtained with sublaminar UCs while further reducing risks of vertebral canal complications.
  
  
  METHODS
  Level IV.
authors.affiliation: Orthopedic Department, Beaujon Hospital, Université Paris-Diderot, AP-HP, 100, boulevard du Général-Leclerc, 92110 Clichy, France. Electronic address: carohirsch@yahoo.fr.
authors.forename: C
authors.initials: C
authors.lastname: Hirsch
authors.affiliation: Pediatric-Orthopedic Department, Robert-Debré Hospital, Université Paris-Diderot, AP-HP, Paris, France.
authors.forename: B
authors.initials: B
authors.lastname: Ilharreborde
authors.affiliation: Pediatric-Orthopedic Department, Clocheville Pediatric Hospital, Université F. Rabelais, Tours, France.
authors.forename: J
authors.initials: J
authors.lastname: Fournier
authors.affiliation: Pediatric-Orthopedic Department, Robert-Debré Hospital, Université Paris-Diderot, AP-HP, Paris, France.
authors.forename: K
authors.initials: K
authors.lastname: Mazda
authors.affiliation: Pediatric-Orthopedic Department, Clocheville Pediatric Hospital, Université F. Rabelais, Tours, France.
authors.forename: C
authors.initials: C
authors.lastname: Bonnard
mesh_terms: D000293:Adolescent; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D016268:Internal Fixators; D008297:Male; D011091:Polyesters; D012189:Retrospective Studies; D012600:Scoliosis / Q000601:surgery*; D013123:Spinal Fusion / Q000295:instrumentation*; D013904:Thoracic Vertebrae / Q000601:surgery*; D013997:Time Factors
chemical_list: D011091:Polyesters
keywords: Adolescent idiopathic scoliosis; Hybrid construct; Posteromedial translation; Universal clamp