Sublaminar fixation versus hooks and pedicle screws in scoliosis surgery for Marfan syndrome
Alessandro Rava1, Eugenio Dema2, Matteo Palmisani2, Rosa Palmisani3, Stefano Cervellati2, Massimo Girardo4
1 Department of Orthopaedic and Traumatology, Orthopaedic and Trauma Centre, Cittá della Salute e della Scienza, University of Turin, Turin, Italy
2 Scoliosis and Spinal Surgery Centre, Hesperia Hospital, Modena, Italy
3 Department of Clinical and Molecular Sciences, School of Medicine, Universitá Politecnica delle Marche, Ancona, Italy
4 Department of Orthopaedic and Traumatology, Spine Surgery Unit, Orthopaedic and Trauma Centre, Cittá della Salute e della Scienza, Turin, Italy
Dr. Alessandro Rava
Department of Orthopaedic and Traumatology, Orthopaedic and Trauma Centre, Cittá della Salute e della Scienza, University of Turin, Via Zuretti 29, 10121 Turin
Source of Support: None, Conflict of Interest: None
Background: In patients with Marfan syndrome (MFS), surgical correction of spinal deformities with hooks and/or pedicle screws involves a higher rate of complications than in patients with adolescent idiopathic scoliosis. Therefore, sublaminar instrumentation is often a last resort option. This study wants to assess the ability of sublaminar fixation to achieve three-dimensional scoliosis correction and spine stabilization compared with hook and/or pedicle screw systems.
Methods: Twenty-one MFS patients who underwent posterior spinal fusion at a highly specialized medical center in 1995–2017 were divided into two different groups retrospectively evaluated at a minimum follow-up of 2 years. Group 1 (8 patients) was composed by hooks and screws instrumentation, while Group 2 (13 patients) was composed by hook or pedicle screw system associated to sublaminar wires/bands. Radiological (correction and long-term stability) and general endpoints (mean blood loss, surgery time, and complications) were compared between the groups.
Results: The degree of correction compared with the preoperative status was satisfactory with both approaches, although the difference between them was not significant. No significant differences were found for general endpoints between groups.
Conclusion: Our data suggest that scoliosis correction with sublaminar fixation is not inferior to treatment with hooks and/or pedicle screws.
Level of Evidence: III.