Turkish Neurosurgery
Does hybrid instrumentation using sublaminar bands give comparable results to all pedicle screw constructs in surgical correction of adolescent idiopathic scoliosis? A systematic review and meta-analysis of current evidence. |
Vishal Kumar1, Sitanshu Barik2, Vikash Raj3, Arvind J Vakar4, Richa Richa5 |
1PostGraduate Institute of Medical Education and Research, Chandigarh, Orthopaedics, Chandigarh, 2All India Institute of Medical Sciences, Nagpur, Orthopaedics, Nagpur, 3All India Institute of Medical Sciences, Deoghar, Orthopaedics, Deoghar, 4Apollo Hospital, Navi Mumbai, Orthopaedics, Mumbai, 5All India Institute of Medical Sciences, Deoghar, Community and Family Medicine, Deoghar, |
DOI: 10.5137/1019-5149.JTN.46366-24.3 |
Objective
This article compares the results of surgical correction of adolescent idiopathic scoliosis (AIS) by posterior instrumentation. Two different types of implants namely the conventional all pedicle screw fixation method (PS) and the hybrid fixation method utilising the sublaminar bands along with pedicle screws (HG) are being compared. The review aims to establish the effectiveness and safety of HG in AIS surgery.
Method
The study adheres to Preferred Reporting Items for Systematic reviews and Meta Analysis (PRISMA) and was registered with PROSPERO. This review included studies conducted on patients having AIS. All studies comparing the outcomes of PS with HG were included.
Results
We found an improvement of the main curve (p = 0.007; SMD (IV, Random) = 0.54; 95% CI [0.15, 0.93]) in the PS group to be statistically significant. The two groups had statistically insignificant differences in the operative time, blood loss, number of levels fused, secondary curve correction and complication rates. We found PS had better outcomes in cases with preoperative hyperkyphosis whereas HG was better for patients with preoperative hypokyphosis. The complications on ling term follow up in the form of distal junctional kyphosis 2 years after surgery is higher in PS (5%).
Conclusion
Hybrid constructs using sublaminar bands along with pedicle screws are safe and effective option for posterior instrumentation of AIS due to reduced incidence of complications like distal junctional kyphosis. They give better deformity correction in sagittal planes hence are more effective in restoring the dorsal kyphosis post-operatively.
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Corresponding author : Vikash Raj