1. Safety of sublaminar bands in surgical correction of adolescent idiopathic scoliosis
Anton Borgers
Lieven Moke
Thibault Dewilde
Pierre Moens
U.Z. Leuven
Belgium
ISOC 2014
MEXICO

2. LEUVEN
MEXICO

3. Introduction
The aim of scoliosis fusion surgery is to stop curve progression and apply three-dimensional correction in order to restore trunk height and to achieve a balanced spine in both the coronal and sagittal plane

4. To this day hybrid constructs, using sublaminar devices, hooks and screws, as well as all-screw constructs are used in surgery of adolescent idiopathic scoliosis.

5. However some pedicle are not « screwable »
This pedicule is thinner than the smallest screw
of my tool box.

6. There has been controversy about the safety of passing steel wires under the lamina into the spinal canal

7. The goal of the present study is to assess the safety of sublaminar polyester bands in the instrumentation for adolescent idiopathic scoliosis.

8. Technical aspects Hybrid instrumentation Hooks Pedicle screws
Universal Clamps

9. Universal Clamp

20. Intraoperative neuromonitoring
Motor evoked potential-monitoring (MEP)
Somatosensory evoked potential-monitoring (SSEP)

21. Patients
71 consecutive patients with adolescent idiopathic scoliosis (07/ /2012)
56 female patients and 15 male patients
Mean age at time of surgery was 16.7 years
Mean follow-up was 17.5 months

22. Lenke type

23. Mean number of levels fused: 11.9 +/- 1.4
Anterior release: 6 cases
Mean number Universal Clamps: 5.9 (range 2 – 9)

24. Results
Mean preoperative Cobb angle of the major curve was 60 +/-19 °.
Mean postoperative Cobb angle was 23 +/-13°.

25. MEP, SSEP’S
Intraoperative neuromonitoring changes were recorded in 8 of 71 patients

26. Two patients developed a transient neurologic deficit after surgery
Only one patients with a postoperative neurologic deficit had intraoperative monitoring changes

27. We analyzed the recorded data for the moment of the monitoring changes and the surgical action performed at that time

28. Neuromonitoring changes

29. Neurologic deficits
A first patient had decreased MEP-signals in the left lower limb during the procedure, SSEP’s remained variable within normal range
After the procedure the patient had a paresis of the left leg (2/5). At day 3 the motor deficit in the left leg had partially recovered (4/5).

30. The second patient noted mild hypoesthesia of both thighs postoperative.
She had no intraoperative monitoring changes.

31. The two patients recovered without sequelae

32. We did not found neuromonitoring changes during insertion or passage of the Universal clamps in this study

33. To be honest
Some weeks ago we have had one neuromonitoring change when passing the band in a very lordotic thoracic spine
The patient had a paresis of the left leg which recovered after some days but had still sensible toubles when going home, to be followed

34. At the EPOS 2014 the group of Marseille presented a similar study about more than 200 patients, with 3 cases of NMC, when passing the band
The sagittal plan and the way of bending the band before insertion were the reasons of the changes

35. Conclusion
We think that passing polyester bands like the Universal Clamp under the lamina remains a safe technique in the surgery of adolescent idiopathic scoliosis

36. Thank you for your attention and greetings from Belgium