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

摘要

STUDY DESIGN: The results of correction for adolescent idiopathic scoliosis (AIS) were compared using apical sublaminar wires versus 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 BACKGROUND 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 degrees in the sublaminar wire and 59.5 degrees 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 the major curve correction was 4.6% in the sublaminar wire compared 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; 8,341 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.