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Spinal loop rectangle and sub laminar wiring as a technique for scoliosis correction.

Bhojraj SY, Varma RG, Nene AM, Mohite S - Indian J Orthop (2010)

Bottom Line: Along with clinicoradiological outcome, patient satisfaction (as per the SRS 24), was accounted.Patient satisfaction results were encouraging in 36 patients as per - SRS24).About 80.2% patients were ready to undergo the same surgery if required. (SRS24).

View Article: PubMed Central - PubMed

Affiliation: Consultant Spine Surgeon, Lilavati Hospital and MRC and Breach Candy Hospital, Mumbai, India.

ABSTRACT

Background: Most literature popularizes the efficacy of third generation instrumentation in the surgical correction of spinal deformities. A cheap and effective scoliotic deformity correction method is reviewed in this article. The aim of this study is to evaluate the efficacy of spinal loop rectangle and sub laminar wires as a modality for spinal deformity correction and its co-relation with patients' satisfaction and clinical outcome.

Material and methods: Thirty six patients of scoliotic spinal deformities with various etiologies (congenital-4, idiopathic- 25, neurofibromatosis-3, neuromuscular-2 and 'syndromic'-3) with ages ranging from 8 to 23 years underwent corrective posterior spinal arthrodesis with stainless steel Hartshill loop rectangle and sublaminar wires. Clinicoradiological evaluation was done at an average follow-up of 6 (1/2) years (min-2 (1/2), years). Along with clinicoradiological outcome, patient satisfaction (as per the SRS 24), was accounted.

Results: Average preoperative Cobb's angle were 73.25 degrees in the entire group and 66.48 degrees in the idiopathic group. Average percentage correction was 64.34% in the entire group and the (average degree of correction was 47.13). In the idiopathic group, the respective values were 69.19% and 46 degrees . Loss of correction in the whole group was 2.2 degrees at two year follow up. Sagittal profiles, truncal balance were well corrected too; minimal complications were seen. Patient satisfaction results were encouraging in 36 patients as per - SRS24). About 80.2% patients were ready to undergo the same surgery if required. (SRS24).

Conclusion: Segmental spinal fixation with locally made spinal loop rectangle and sublaminar wires is comparable as a modality to correct scoliotic spinal deformities.

No MeSH data available.


Related in: MedlinePlus

Pre operative (a,b) and post operative (c,d) x-rays of dorso lumbar spine shows good correction, balance and maintenance of a scoliotic deformity at 4 ½ years follow up. Intraoperative photographs show different stages of instrumentation (e-h)
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Figure 0002: Pre operative (a,b) and post operative (c,d) x-rays of dorso lumbar spine shows good correction, balance and maintenance of a scoliotic deformity at 4 ½ years follow up. Intraoperative photographs show different stages of instrumentation (e-h)

Mentions: Once the midline posterior exposure was complete lateral up to the transverse processes, the sublaminar spaces are created by cutting the interspinous ligaments and midline ligamentum flavum. This is a key step. Once the sublaminar spaces are exposed in the entire levels to be instrumented 20 gauge stainless steel double looped wires are passed at each level (in caudal to cephalad direction). The facetal preparation for fusion is then done which also helps some amount of posterior release. The size of loop rectangle required is then measured and adequately contoured (very important for sagittal balance). Wires are tied onto the loop rectangle with cephalad wire ends inside the loop rectangle and caudad wire ends outside the loop rectangle at each level (except at the lower end of the construct where it is reversed to prevent the down slide of the construct)/ Tightening of concave wires first at each level was done which causes translation of curve on to the loop rectangle and then the wires at convex sides to play a role in derotating the curve. Two more final tightening, correct the spinal deformity onto the loop rectangle. After packing the sublaminar spaces with gel foam, thorough shingling and graft bed preparation for posterior fusion is undertaken [Figure 2].


Spinal loop rectangle and sub laminar wiring as a technique for scoliosis correction.

Bhojraj SY, Varma RG, Nene AM, Mohite S - Indian J Orthop (2010)

Pre operative (a,b) and post operative (c,d) x-rays of dorso lumbar spine shows good correction, balance and maintenance of a scoliotic deformity at 4 ½ years follow up. Intraoperative photographs show different stages of instrumentation (e-h)
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC2822420&req=5

Figure 0002: Pre operative (a,b) and post operative (c,d) x-rays of dorso lumbar spine shows good correction, balance and maintenance of a scoliotic deformity at 4 ½ years follow up. Intraoperative photographs show different stages of instrumentation (e-h)
Mentions: Once the midline posterior exposure was complete lateral up to the transverse processes, the sublaminar spaces are created by cutting the interspinous ligaments and midline ligamentum flavum. This is a key step. Once the sublaminar spaces are exposed in the entire levels to be instrumented 20 gauge stainless steel double looped wires are passed at each level (in caudal to cephalad direction). The facetal preparation for fusion is then done which also helps some amount of posterior release. The size of loop rectangle required is then measured and adequately contoured (very important for sagittal balance). Wires are tied onto the loop rectangle with cephalad wire ends inside the loop rectangle and caudad wire ends outside the loop rectangle at each level (except at the lower end of the construct where it is reversed to prevent the down slide of the construct)/ Tightening of concave wires first at each level was done which causes translation of curve on to the loop rectangle and then the wires at convex sides to play a role in derotating the curve. Two more final tightening, correct the spinal deformity onto the loop rectangle. After packing the sublaminar spaces with gel foam, thorough shingling and graft bed preparation for posterior fusion is undertaken [Figure 2].

Bottom Line: Along with clinicoradiological outcome, patient satisfaction (as per the SRS 24), was accounted.Patient satisfaction results were encouraging in 36 patients as per - SRS24).About 80.2% patients were ready to undergo the same surgery if required. (SRS24).

View Article: PubMed Central - PubMed

Affiliation: Consultant Spine Surgeon, Lilavati Hospital and MRC and Breach Candy Hospital, Mumbai, India.

ABSTRACT

Background: Most literature popularizes the efficacy of third generation instrumentation in the surgical correction of spinal deformities. A cheap and effective scoliotic deformity correction method is reviewed in this article. The aim of this study is to evaluate the efficacy of spinal loop rectangle and sub laminar wires as a modality for spinal deformity correction and its co-relation with patients' satisfaction and clinical outcome.

Material and methods: Thirty six patients of scoliotic spinal deformities with various etiologies (congenital-4, idiopathic- 25, neurofibromatosis-3, neuromuscular-2 and 'syndromic'-3) with ages ranging from 8 to 23 years underwent corrective posterior spinal arthrodesis with stainless steel Hartshill loop rectangle and sublaminar wires. Clinicoradiological evaluation was done at an average follow-up of 6 (1/2) years (min-2 (1/2), years). Along with clinicoradiological outcome, patient satisfaction (as per the SRS 24), was accounted.

Results: Average preoperative Cobb's angle were 73.25 degrees in the entire group and 66.48 degrees in the idiopathic group. Average percentage correction was 64.34% in the entire group and the (average degree of correction was 47.13). In the idiopathic group, the respective values were 69.19% and 46 degrees . Loss of correction in the whole group was 2.2 degrees at two year follow up. Sagittal profiles, truncal balance were well corrected too; minimal complications were seen. Patient satisfaction results were encouraging in 36 patients as per - SRS24). About 80.2% patients were ready to undergo the same surgery if required. (SRS24).

Conclusion: Segmental spinal fixation with locally made spinal loop rectangle and sublaminar wires is comparable as a modality to correct scoliotic spinal deformities.

No MeSH data available.


Related in: MedlinePlus