Apical sublaminar wires versus pedicle screws - Which provides better results for surgical correction of adolescent idiopathic scoliosis?

Ivan Cheng, Yongjung Kim, Munish C. Gupta, Keith H. Bridwell, Robert K. Hurford, Stanley S. Lee, Thongchai Theerajunyaporn, Lawrence G. Lenke

Research output: Contribution to journalArticle

120 Citations (Scopus)

Abstract

Study Design. The results of correction for adolescent idiopathic scoliosis (AIS) were compared using apical sublaminar wires versos pedicle screws. Objective. To compare comprehensively the 2-year minimum postoperative results of posterior correction and spinal fusion using translational correction through either hybrid hook/sublaminar wire/pedicle screw constructs versus in situ rod-contouring correction with pedicle screw constructs in the treatment of AIS at 2 institutions. Summary of Bagkground Data. Despite the reports of satisfactory correction of scoliotic curves by both apical (sublaminar wire) instrumentation and apical pedicle screw instrumentation, to our knowledge, no reports on the comprehensive comparison of hybrid (hook/sublaminar wire/pedicle screw) instrumentation versus segmental pedicle screw instrumentation exist. Methods. A total of 50 patients with AIS at 2 institutions who underwent posterior spinal fusion with sublaminar wire (25 patients) or pedicle screw (25) constructs were sorted and matched according to 4 criteria: (1) similar age at surgery (14.2 years in the sublaminar wire and 14.4 in the pedicle screw group, P = 0.72); (2) similar number of fused vertebrae (11.4 in the sublaminar wire and 11.8 in the pedicle screw group, P= 0.36); (3) similar operative methods; and (4) identical Lenke curve types and similar preoperative major curve measurements (63.5° in the sublamiriar wire and 59.5° in the pedicle Screw group, P = 0.42). Patients were evaluated preoperatively, Immediately postoperatively, and at 2-year follow-up according to radiographic changes in curve correction, operating time, intraoperative blood loss, implant costs, and the Scoliosis Research Society patient questionnaire (SRS-24) scores. Results. After surgery, average major curve correction was 67.4% in the sublaminar wire and 68.1% in the pedicle screw group (P = 0.56). At 2-year follow-up, loss of themajor curve correction was 4.6% in the sublaminar wirecompared to 5.1% in the pedicle screw group (P = 0.79). Postoperative global coronal and sagittal balance were similar in both groups. No significant difference was found in the average number of levels fused from the distal end vertebra (1.48 in the sublaminar wire and 0.64 in the pedicle screw group, P = 0.21). Operating time averaged 350 minutes in the sublaminar wire and 357 in the pedicle screw group (P = 0.86). Intraoperative blood loss was significantly different in both groups (1791 ± 816 mL in the sublaminar wire and 824 ± 440 mL in the pedicle screw group) (P = 0.0003). Average implant cost in the sublaminar wire group (16.0 fixation points; 8341 US dollars) was significantly lower than that of the pedicle screw group (17.1 fixation points; 13,462 US dollars) (P < 0.0001). Postoperative 2-year SRS-24 scores were similar in both groups (sublaminar wire = 107.3, pedicle screw = 103.5, P = 0.19). There were no neurologic or visceral complications related to sublaminar wire or pedicle screw instrumentation and no reoperations at a minimum 2-year follow-up. Conclusions. Apical sublaminar wire and pedicle screw instrumentation both offer similar major curve correction with similar fusion lengths without neurologic problems in the operative treatment of AIS. Although more expensive, pedicle screw constructs had significantly less blood loss and slightly shorter fusion lengths than the sublaminar wire constructs.

Original languageEnglish (US)
Pages (from-to)2104-2112
Number of pages9
JournalSpine
Volume30
Issue number18
DOIs
StatePublished - Sep 15 2005

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Scoliosis
Pedicle Screws
Spinal Fusion
Nervous System
Spine
Costs and Cost Analysis

Keywords

  • Adolescent idiopathic scoliosis
  • Apical sublaminar wires
  • Cotrel-Dubousset instrumentation
  • Harrington rod
  • Luque instrumentation
  • Miami-Moss instrumentation
  • Pedicle screws

ASJC Scopus subject areas

  • Physiology
  • Clinical Neurology
  • Orthopedics and Sports Medicine

Cite this

Apical sublaminar wires versus pedicle screws - Which provides better results for surgical correction of adolescent idiopathic scoliosis? / Cheng, Ivan; Kim, Yongjung; Gupta, Munish C.; Bridwell, Keith H.; Hurford, Robert K.; Lee, Stanley S.; Theerajunyaporn, Thongchai; Lenke, Lawrence G.

In: Spine, Vol. 30, No. 18, 15.09.2005, p. 2104-2112.

Research output: Contribution to journalArticle

Cheng, I, Kim, Y, Gupta, MC, Bridwell, KH, Hurford, RK, Lee, SS, Theerajunyaporn, T & Lenke, LG 2005, 'Apical sublaminar wires versus pedicle screws - Which provides better results for surgical correction of adolescent idiopathic scoliosis?', Spine, vol. 30, no. 18, pp. 2104-2112. https://doi.org/10.1097/01.brs.0000179261.70845.b7
Cheng, Ivan ; Kim, Yongjung ; Gupta, Munish C. ; Bridwell, Keith H. ; Hurford, Robert K. ; Lee, Stanley S. ; Theerajunyaporn, Thongchai ; Lenke, Lawrence G. / Apical sublaminar wires versus pedicle screws - Which provides better results for surgical correction of adolescent idiopathic scoliosis?. In: Spine. 2005 ; Vol. 30, No. 18. pp. 2104-2112.
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title = "Apical sublaminar wires versus pedicle screws - Which provides better results for surgical correction of adolescent idiopathic scoliosis?",
abstract = "Study Design. The results of correction for adolescent idiopathic scoliosis (AIS) were compared using apical sublaminar wires versos pedicle screws. Objective. To compare comprehensively the 2-year minimum postoperative results of posterior correction and spinal fusion using translational correction through either hybrid hook/sublaminar wire/pedicle screw constructs versus in situ rod-contouring correction with pedicle screw constructs in the treatment of AIS at 2 institutions. Summary of Bagkground Data. Despite the reports of satisfactory correction of scoliotic curves by both apical (sublaminar wire) instrumentation and apical pedicle screw instrumentation, to our knowledge, no reports on the comprehensive comparison of hybrid (hook/sublaminar wire/pedicle screw) instrumentation versus segmental pedicle screw instrumentation exist. Methods. A total of 50 patients with AIS at 2 institutions who underwent posterior spinal fusion with sublaminar wire (25 patients) or pedicle screw (25) constructs were sorted and matched according to 4 criteria: (1) similar age at surgery (14.2 years in the sublaminar wire and 14.4 in the pedicle screw group, P = 0.72); (2) similar number of fused vertebrae (11.4 in the sublaminar wire and 11.8 in the pedicle screw group, P= 0.36); (3) similar operative methods; and (4) identical Lenke curve types and similar preoperative major curve measurements (63.5° in the sublamiriar wire and 59.5° in the pedicle Screw group, P = 0.42). Patients were evaluated preoperatively, Immediately postoperatively, and at 2-year follow-up according to radiographic changes in curve correction, operating time, intraoperative blood loss, implant costs, and the Scoliosis Research Society patient questionnaire (SRS-24) scores. Results. After surgery, average major curve correction was 67.4{\%} in the sublaminar wire and 68.1{\%} in the pedicle screw group (P = 0.56). At 2-year follow-up, loss of themajor curve correction was 4.6{\%} in the sublaminar wirecompared to 5.1{\%} in the pedicle screw group (P = 0.79). Postoperative global coronal and sagittal balance were similar in both groups. No significant difference was found in the average number of levels fused from the distal end vertebra (1.48 in the sublaminar wire and 0.64 in the pedicle screw group, P = 0.21). Operating time averaged 350 minutes in the sublaminar wire and 357 in the pedicle screw group (P = 0.86). Intraoperative blood loss was significantly different in both groups (1791 ± 816 mL in the sublaminar wire and 824 ± 440 mL in the pedicle screw group) (P = 0.0003). Average implant cost in the sublaminar wire group (16.0 fixation points; 8341 US dollars) was significantly lower than that of the pedicle screw group (17.1 fixation points; 13,462 US dollars) (P < 0.0001). Postoperative 2-year SRS-24 scores were similar in both groups (sublaminar wire = 107.3, pedicle screw = 103.5, P = 0.19). There were no neurologic or visceral complications related to sublaminar wire or pedicle screw instrumentation and no reoperations at a minimum 2-year follow-up. Conclusions. Apical sublaminar wire and pedicle screw instrumentation both offer similar major curve correction with similar fusion lengths without neurologic problems in the operative treatment of AIS. Although more expensive, pedicle screw constructs had significantly less blood loss and slightly shorter fusion lengths than the sublaminar wire constructs.",
keywords = "Adolescent idiopathic scoliosis, Apical sublaminar wires, Cotrel-Dubousset instrumentation, Harrington rod, Luque instrumentation, Miami-Moss instrumentation, Pedicle screws",
author = "Ivan Cheng and Yongjung Kim and Gupta, {Munish C.} and Bridwell, {Keith H.} and Hurford, {Robert K.} and Lee, {Stanley S.} and Thongchai Theerajunyaporn and Lenke, {Lawrence G.}",
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language = "English (US)",
volume = "30",
pages = "2104--2112",
journal = "Spine",
issn = "0362-2436",
publisher = "Lippincott Williams and Wilkins",
number = "18",

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TY - JOUR

T1 - Apical sublaminar wires versus pedicle screws - Which provides better results for surgical correction of adolescent idiopathic scoliosis?

AU - Cheng, Ivan

AU - Kim, Yongjung

AU - Gupta, Munish C.

AU - Bridwell, Keith H.

AU - Hurford, Robert K.

AU - Lee, Stanley S.

AU - Theerajunyaporn, Thongchai

AU - Lenke, Lawrence G.

PY - 2005/9/15

Y1 - 2005/9/15

N2 - Study Design. The results of correction for adolescent idiopathic scoliosis (AIS) were compared using apical sublaminar wires versos pedicle screws. Objective. To compare comprehensively the 2-year minimum postoperative results of posterior correction and spinal fusion using translational correction through either hybrid hook/sublaminar wire/pedicle screw constructs versus in situ rod-contouring correction with pedicle screw constructs in the treatment of AIS at 2 institutions. Summary of Bagkground Data. Despite the reports of satisfactory correction of scoliotic curves by both apical (sublaminar wire) instrumentation and apical pedicle screw instrumentation, to our knowledge, no reports on the comprehensive comparison of hybrid (hook/sublaminar wire/pedicle screw) instrumentation versus segmental pedicle screw instrumentation exist. Methods. A total of 50 patients with AIS at 2 institutions who underwent posterior spinal fusion with sublaminar wire (25 patients) or pedicle screw (25) constructs were sorted and matched according to 4 criteria: (1) similar age at surgery (14.2 years in the sublaminar wire and 14.4 in the pedicle screw group, P = 0.72); (2) similar number of fused vertebrae (11.4 in the sublaminar wire and 11.8 in the pedicle screw group, P= 0.36); (3) similar operative methods; and (4) identical Lenke curve types and similar preoperative major curve measurements (63.5° in the sublamiriar wire and 59.5° in the pedicle Screw group, P = 0.42). Patients were evaluated preoperatively, Immediately postoperatively, and at 2-year follow-up according to radiographic changes in curve correction, operating time, intraoperative blood loss, implant costs, and the Scoliosis Research Society patient questionnaire (SRS-24) scores. Results. After surgery, average major curve correction was 67.4% in the sublaminar wire and 68.1% in the pedicle screw group (P = 0.56). At 2-year follow-up, loss of themajor curve correction was 4.6% in the sublaminar wirecompared to 5.1% in the pedicle screw group (P = 0.79). Postoperative global coronal and sagittal balance were similar in both groups. No significant difference was found in the average number of levels fused from the distal end vertebra (1.48 in the sublaminar wire and 0.64 in the pedicle screw group, P = 0.21). Operating time averaged 350 minutes in the sublaminar wire and 357 in the pedicle screw group (P = 0.86). Intraoperative blood loss was significantly different in both groups (1791 ± 816 mL in the sublaminar wire and 824 ± 440 mL in the pedicle screw group) (P = 0.0003). Average implant cost in the sublaminar wire group (16.0 fixation points; 8341 US dollars) was significantly lower than that of the pedicle screw group (17.1 fixation points; 13,462 US dollars) (P < 0.0001). Postoperative 2-year SRS-24 scores were similar in both groups (sublaminar wire = 107.3, pedicle screw = 103.5, P = 0.19). There were no neurologic or visceral complications related to sublaminar wire or pedicle screw instrumentation and no reoperations at a minimum 2-year follow-up. Conclusions. Apical sublaminar wire and pedicle screw instrumentation both offer similar major curve correction with similar fusion lengths without neurologic problems in the operative treatment of AIS. Although more expensive, pedicle screw constructs had significantly less blood loss and slightly shorter fusion lengths than the sublaminar wire constructs.

AB - Study Design. The results of correction for adolescent idiopathic scoliosis (AIS) were compared using apical sublaminar wires versos pedicle screws. Objective. To compare comprehensively the 2-year minimum postoperative results of posterior correction and spinal fusion using translational correction through either hybrid hook/sublaminar wire/pedicle screw constructs versus in situ rod-contouring correction with pedicle screw constructs in the treatment of AIS at 2 institutions. Summary of Bagkground Data. Despite the reports of satisfactory correction of scoliotic curves by both apical (sublaminar wire) instrumentation and apical pedicle screw instrumentation, to our knowledge, no reports on the comprehensive comparison of hybrid (hook/sublaminar wire/pedicle screw) instrumentation versus segmental pedicle screw instrumentation exist. Methods. A total of 50 patients with AIS at 2 institutions who underwent posterior spinal fusion with sublaminar wire (25 patients) or pedicle screw (25) constructs were sorted and matched according to 4 criteria: (1) similar age at surgery (14.2 years in the sublaminar wire and 14.4 in the pedicle screw group, P = 0.72); (2) similar number of fused vertebrae (11.4 in the sublaminar wire and 11.8 in the pedicle screw group, P= 0.36); (3) similar operative methods; and (4) identical Lenke curve types and similar preoperative major curve measurements (63.5° in the sublamiriar wire and 59.5° in the pedicle Screw group, P = 0.42). Patients were evaluated preoperatively, Immediately postoperatively, and at 2-year follow-up according to radiographic changes in curve correction, operating time, intraoperative blood loss, implant costs, and the Scoliosis Research Society patient questionnaire (SRS-24) scores. Results. After surgery, average major curve correction was 67.4% in the sublaminar wire and 68.1% in the pedicle screw group (P = 0.56). At 2-year follow-up, loss of themajor curve correction was 4.6% in the sublaminar wirecompared to 5.1% in the pedicle screw group (P = 0.79). Postoperative global coronal and sagittal balance were similar in both groups. No significant difference was found in the average number of levels fused from the distal end vertebra (1.48 in the sublaminar wire and 0.64 in the pedicle screw group, P = 0.21). Operating time averaged 350 minutes in the sublaminar wire and 357 in the pedicle screw group (P = 0.86). Intraoperative blood loss was significantly different in both groups (1791 ± 816 mL in the sublaminar wire and 824 ± 440 mL in the pedicle screw group) (P = 0.0003). Average implant cost in the sublaminar wire group (16.0 fixation points; 8341 US dollars) was significantly lower than that of the pedicle screw group (17.1 fixation points; 13,462 US dollars) (P < 0.0001). Postoperative 2-year SRS-24 scores were similar in both groups (sublaminar wire = 107.3, pedicle screw = 103.5, P = 0.19). There were no neurologic or visceral complications related to sublaminar wire or pedicle screw instrumentation and no reoperations at a minimum 2-year follow-up. Conclusions. Apical sublaminar wire and pedicle screw instrumentation both offer similar major curve correction with similar fusion lengths without neurologic problems in the operative treatment of AIS. Although more expensive, pedicle screw constructs had significantly less blood loss and slightly shorter fusion lengths than the sublaminar wire constructs.

KW - Adolescent idiopathic scoliosis

KW - Apical sublaminar wires

KW - Cotrel-Dubousset instrumentation

KW - Harrington rod

KW - Luque instrumentation

KW - Miami-Moss instrumentation

KW - Pedicle screws

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