SubLaminar Polyester Band Fixation Construct in the Treatment

Sub-Laminar Polyester Band Fixation Construct in the Treatment of Neuromuscular Scoliosis: A Preliminary Report S. Rosenfeld MD, S. Kenney DO MPH, E. Rebich DO Department of Orthopedic Surgery, Children’s Hospital of Orange County (CHOC), Orange CA

Introduction • Spinal deformity correction is a mainstay in the treatment of neuromuscular scoliosis • Multiple implants are available including pedicle screws, hooks, wires, and sub laminar bands • Most constructs using sub laminar bands are hybrid constructs especially at the most cephalad level of correction

Purpose • The purpose of this study was to assess outcomes of a sub laminar band predominant construct used to treat pediatric neuromuscular scoliosis

Methodology • Retrospective review of 28 cases • Single surgeon at single center • Correction calculated by comparing preoperative and post-operative radiographs • Clinical outcomes including complications were assessed • Peri-operative data including EBL and duration of surgery were analyzed.

Sample Radiographic Correction

Results • 28 patients with neuromuscular scoliosis included • Cases included from 2013 -2016 • Average post operative coronal correction was 53% (0 -92%) • Sagittal balance was corrected to within 2 cm of C 7 plumb line in 76% of patients

Results • Post-operative lumbar lordosis angle was within normal limits in all patients • Average thoracic kyphosis angle increased by 9 degrees post operatively • Average post operative pelvic obliquity decreased by 50%

Results • Average blood loss was lower than that reported in studies of pedicle and hybrid constructs (1600 ml) • Average surgical time was 294 min • Complications – 1 post-operative seroma that required I&D – 10 minor complications that resolved without permanent effect and did not require a procedure in the operating room

Discussion • Sub laminar band constructs are viable treatment options with comparable and sometimes improved outcomes compared to other fixation constructs • To our knowledge this study is the only study that investigates outcomes of constructs that include sub laminar bands at the top of the construct.

Discussion • Sub laminar bands may be easier to place and with less complications than other devices such as pedicle screws • 2 year data on all patients is needed to evaluate maintenance of deformity correction

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Disclosures • The Principal Investigator is an unpaid consultant for Medicrea • The Principal investigator and all members of the research team do not receive any financial or non-financial compensation from third parties including device manufacturers.