Top

Journal of Children's Orthopaedics

Published in:

01-08-2011 | Original Clinical Article

Use of the Universal Clamp in adolescent idiopathic scoliosis for deformity correction and as an adjunct to fusion: 2-year follow-up

Authors: Jérôme Sale de Gauzy, Jean-Luc Jouve, Franck Accadbled, Benjamin Blondel, Gérard Bollini

Published in: Journal of Children's Orthopaedics | Issue 4/2011

Abstract

Purpose

Among posterior surgical techniques for treating adolescent idiopathic scoliosis (AIS), hybrid constructs with pedicle-screw fixation in the lumbar spine and other anchors in the thoracic spine have been reported to provide to be of more physiological value in postoperative thoracic kyphosis than all-screw constructs. The Universial Clamp (UC) equipped with a soft sublaminar band is a relatively new thoracic anchor that can be used in hybrid constructs. A dedicated reduction tool that applies traction to the sublaminar band permits gentle translation of the thoracic curve to the precontoured fusion rods, which have been previously anchored distally by pedicle screws and proximally by hooks in a claw configuration. The aim of this study was to evaluate radiographic results of AIS treatment using UC hybrid constructs.

Methods

This was a prospective case series in which 29 consecutive patients with Lenke type 1, 2 or 3 AIS operated on by two surgeons in two centers were followed for 24 months. Necessity for anterior release was an exclusion criterion.

Results

A total of 5.4 ± 1.4 UCs were used per patient. The major thoracic curve was reduced from 55 ± 7° to 14 ± 6° at 1 month and 17 ± 6° at 24 months (correction 70%) without complications. In the patients who had less than 20° of T5–T12 kyphosis preoperatively, thoracic kyphosis improved from 14 ± 4° to 20 ± 3° at 3 months and 24 ± 9° at 24 months. In the other patients, preoperative thoracic kyphosis (27° ± 6°) was unchanged by the operation.

Conclusion

UC hybrid constructs appear to safely provide satisfying coronal correction while consistently improving thoracic kyphosis in patients who also have preoperative hypokyphosis. We hypothesize that diminution in thoracic kyphosis was consistently avoided due to the straightforward traction of the spine to the fusion rods into which the chosen kyphosis was contoured by the surgeon before applying the reduction tool to the sublaminar bands.

Available only for authorised users

Daffner SD, Beimesch CF, Wang JC (2010) Geographic and demographic variability of cost and surgical treatment of idiopathic scoliosis. Spine (Phila Pa 1976) 35:1165–1169

Hicks JM, Singla A, Shen FH, Arlet V (2010) Complications of pedicle screw fixation in scoliosis surgery: a systematic review. Spine (Phila Pa 1976) 35:E465–E470

Vora V, Crawford A, Babekhir N, Boachie-Adjei O, Lenke L, Peskin M, Charles G, Kim Y (2007) A pedicle screw construct gives an enhanced posterior correction of adolescent idiopathic scoliosis when compared with other constructs: myth or reality. Spine 32:1869–1874CrossRef

Kim YJ, Lenke LG, Cho SK, Bridwell KH, Sides B, Blanke K (2004) Comparative analysis of pedicle screw versus hook instrumentation in posterior spinal fusion of adolescent idiopathic scoliosis. Spine 29:2040–2048CrossRef

Lenke LG, Kuklo TR, Ondra S, Polly DW Jr (2008) Rationale behind the current state-of-the-art treatment of scoliosis (in the pedicle screw era). Spine 33:1051–1054CrossRef

Suk SI, Lee SM, Chung ER, Kim JH, Kim SS (2005) Selective thoracic fusion with segmental pedicle screw fixation in the treatment of thoracic idiopathic scoliosis: more than 5-year follow-up. Spine 30:1602–1609CrossRef

Cheng I, Kim Y, Gupta MC, Bridwell KH, Hurford RK, Lee SS, Theerajunyaporn T, Lenke LG (2005) Apical sublaminar wires versus pedicle screws—which provides better results for surgical correction of adolescent idiopathic scoliosis? Spine 30:2104–2112CrossRef

Lowenstein JE, Matsumoto H, Vitale MG, Weidenbaum M, Gomez JA, Lee FY, Hyman JE, Roye DP Jr (2007) Coronal and sagittal plane correction in adolescent idiopathic scoliosis: a comparison between all pedicle screw versus hybrid thoracic hook lumbar screw constructs. Spine 32:448–452CrossRef

Bergeson RK, Schwend RM, DeLucia T, Silva SR, Smith JE, Avilucea FR (2008) How accurately do novice surgeons place thoracic pedicle screws with the free hand technique? Spine (Phila Pa 1976) 33:E501–E507

10.

Foxx KC, Kwak RC, Latzman JM, Samadani U (2010) A retrospective analysis of pedicle screws in contact with the great vessels. J Neurosurg Spine 13:403–406CrossRef

11.

Senaran H, Shah SA, Gabos PG, Littleton AG, Neiss G, Guille JT (2008) Difficult thoracic pedicle screw placement in adolescent idiopathic scoliosis. J Spinal Disord Tech 21:187–191CrossRef

12.

Winter RB, Lonstein JE, Denis F (2007) How much correction is enough? Spine 32:2641–2643CrossRef

13.

Ilharreborde B, Even J, Lefevre Y, Fitoussi F, Presedo A, Pennecot GF, Mazda K (2010) Hybrid constructs for tridimensional correction of the thoracic spine in adolescent idiopathic scoliosis: a comparative analysis of Universal Clamps versus hooks. Spine (Phila Pa 1976) 35:306–314

14.

Takahata M, Ito M, Abumi K, Kotani Y, Sudo H, Ohshima S, Minami A (2007) Comparison of novel ultra-high molecular weight polyethylene tape versus conventional metal wire for sublaminar segmental fixation in the treatment of adolescent idiopathic scoliosis. J Spinal Disord Tech 20:449–455CrossRef

15.

Jouve JL, de Gauzy JS, Blondel B, Launay F, Accadbled F, Bollini G (2010) Use of the Universal Clamp for deformity correction and as an adjunct to fusion: preliminary results in scoliosis. J Child Orthop 4:73–80CrossRef

16.

Mazda K, Ilharreborde B, Even J, Lefevre Y, Fitoussi F, Pennecot GF (2009) Efficacy and safety of posteromedial translation for correction of thoracic curves in adolescent idiopathic scoliosis using a new connection to the spine: the Universal Clamp. Eur Spine J 18:158–169CrossRef

17.

Bernard TN Jr, Johnston CE II, Roberts JM, Burke SW (1983) Late complications due to wire breakage in segmental spinal instrumentation. Report of two cases. J Bone Joint Surg Am 65:1339–1345

18.

Nicastro JF, Hartjen CA, Traina J, Lancaster JM (1986) Intraspinal pathways taken by sublaminar wires during removal. An experimental study. J Bone Joint Surg Am 68:1206–1209

19.

Schrader WC, Bethem D, Scerbin V (1988) The chronic local effects of sublaminar wires. An animal model. Spine (Phila Pa 1976) 13:499–502

20.

La Rosa G, Giglio G, Oggiano L (2011) Surgical treatment of neurological scoliosis using hybrid construct (lumbar transpedicular screws plus thoracic sublaminar acrylic loops). Eur Spine J 20[Suppl 1]:S90–S94CrossRef

21.

Gazzeri R, Faiola A, Galarza M, Tamorri M (2009) Universal Clamp system in thoracolumbar spinal fixation: technical note. Acta Neurochir (Wien) 151:1673–1680CrossRef

22.

Li G, Lv G, Passias P, Kozanek M, Metkar US, Liu Z, Wood KB, Rehak L, Deng Y Complications associated with thoracic pedicle screws in spinal deformity. Eur Spine J 19:1576–1584

23.

Luque ER (1982) Segmental spinal instrumentation for correction of scoliosis. Clin Orthop Relat Res 163:192–198

24.

Polly DW Jr, Potter BK, Kuklo T, Young S, Johnson C, Klemme WR (2004) Volumetric spinal canal intrusion: a comparison between thoracic pedicle screws and thoracic hooks. Spine 29(1):63–69CrossRef

25.

Schlenzka D, Poussa M, Muschik M (1993) Operative treatment of adolescent idiopathic thoracic scoliosis. Harrington-DTT versus Cotrel-Dubousset instrumentation. Clin Orthop Relat Res 297:155–160

26.

van Laar W, Meester RJ, Smit TH, van Royen BJ (2007) A biomechanical analysis of the self-retaining pedicle hook device in posterior spinal fixation. Eur Spine J 16:1209–1214CrossRef

27.

Wilber RG, Thompson GH, Shaffer JW, Brown RH, Nash CL Jr (1984) Postoperative neurological deficits in segmental spinal instrumentation. A study using spinal cord monitoring. J Bone Joint Surg Am 66:1178–1187

28.

Kim YJ, Lenke LG, Kim J, Bridwell KH, Cho SK, Cheh G, Sides B (2006) Comparative analysis of pedicle screw versus hybrid instrumentation in posterior spinal fusion of adolescent idiopathic scoliosis. Spine 31:291–298CrossRef

29.

Lehman RA Jr, Lenke LG, Keeler KA, Kim YJ, Buchowski JM, Cheh G, Kuhns CA, Bridwell KH (2008) Operative treatment of adolescent idiopathic scoliosis with posterior pedicle screw-only constructs: minimum three-year follow-up of one hundred fourteen cases. Spine (Phila Pa 1976) 33:1598–1604

30.

Luhmann SJ, Lenke LG, Kim YJ, Bridwell KH, Schootman M (2005) Thoracic adolescent idiopathic scoliosis curves between 70 degrees and 100 degrees: is anterior release necessary? Spine (Phila Pa 1976) 30:2061–2067

31.

Newton PO, Yaszay B, Upasani VV, Pawelek JB, Bastrom TP, Lenke LG, Lowe T, Crawford A, Betz R, Lonner B (2010) Preservation of thoracic kyphosis is critical to maintain lumbar lordosis in the surgical treatment of adolescent idiopathic scoliosis. Spine (Phila Pa 1976) 35:1365–1370

32.

Potter BK, Kuklo TR, Lenke LG (2005) Radiographic outcomes of anterior spinal fusion versus posterior spinal fusion with thoracic pedicle screws for treatment of Lenke Type I adolescent idiopathic scoliosis curves. Spine (Phila Pa 1976) 30:1859–1866

33.

Quan GM, Gibson MJ (2010) Correction of main thoracic adolescent idiopathic scoliosis using pedicle screw instrumentation: does higher implant density improve correction? Spine (Phila Pa 1976) 35:562–567

34.

Karatoprak O, Unay K, Tezer M, Ozturk C, Aydogan M, Mirzanli C (2008) Comparative analysis of pedicle screw versus hybrid instrumentation in adolescent idiopathic scoliosis surgery. Int Orthop 32:523–528; discussion 529

35.

Lee SM, Suk SI, Chung ER (2004) Direct vertebral rotation: a new technique of three-dimensional deformity correction with segmental pedicle screw fixation in adolescent idiopathic scoliosis. Spine 29:343–349CrossRef

36.

Lonner BS, Auerbach JD, Estreicher M, Milby AH, Kean KE (2009) Video-assisted thoracoscopic spinal fusion compared with posterior spinal fusion with thoracic pedicle screws for thoracic adolescent idiopathic scoliosis. J Bone Joint Surg Am 91:398–408CrossRef

37.

Suk SI, Kim WJ, Kim JH, Lee SM (1999) Restoration of thoracic kyphosis in the hypokyphotic spine: a comparison between multiple-hook and segmental pedicle screw fixation in adolescent idiopathic scoliosis. J Spinal Disord 12:489–495

38.

Clement JL, Chau E, Kimkpe C, Vallade MJ (2008) Restoration of thoracic kyphosis by posterior instrumentation in adolescent idiopathic scoliosis: comparative radiographic analysis of two methods of reduction. Spine (Phila Pa 1976) 33:1579–1587

39.

Vallespir GP, Flores JB, Trigueros IS, Sierra EH, Fernandez PD, Olaverri JC, Alonso MG, Galea RR, Francisco AP, Rodriguez de Paz B, Carbonell PG, Thomas JV, Lopez JL, Paulino JI, Pitarque CB, Garcia OR (2008) Vertebral coplanar alignment: a standardized technique for three dimensional correction in scoliosis surgery: technical description and preliminary results in Lenke type 1 curves. Spine (Phila Pa 1976) 33:1588–1597

40.

Lenke LG, Edwards CC, 2nd, Bridwell KH (2003) The Lenke classification of adolescent idiopathic scoliosis: how it organizes curve patterns as a template to perform selective fusions of the spine. Spine (Phila Pa 1976) 28:S199–S207

41.

Remes V, Helenius I, Schlenzka D, Yrjonen T, Ylikoski M, Poussa M (2004) Cotrel-Dubousset (CD) or Universal Spine System (USS) instrumentation in adolescent idiopathic scoliosis (AIS): comparison of midterm clinical, functional, and radiologic outcomes. Spine 29:2024–2030CrossRef

42.

Takahashi S, Passuti N, Delecrin J (1997) Interpretation and utility of traction radiography in scoliosis surgery. Analysis of patients treated with Cotrel-Dubousset instrumentation. Spine 22:2542–2546CrossRef

43.

Boos N, Dolan LA, Weinstein SL (2007) Long-term clinical and radiographic results of Cotrel-Dubousset instrumentation of right thoracic adolescent idiopathic scoliosis. Iowa Orthop J 27:40–46

44.

Sucato DJ, Agrawal S, O’Brien MF, Lowe TG, Richards SB, Lenke L (2008) Restoration of thoracic kyphosis after operative treatment of adolescent idiopathic scoliosis: a multicenter comparison of three surgical approaches. Spine (Phila Pa 1976) 33:2630–2636

45.

Muschik MT, Kimmich H, Demmel T (2006) Comparison of anterior and posterior double-rod instrumentation for thoracic idiopathic scoliosis: results of 141 patients. Eur Spine J 15:1128–1138CrossRef

46.

Perez-Grueso FS, Fernandez-Baillo N, Arauz de Robles S, Garcia Fernandez A (2000) The low lumbar spine below Cotrel-Dubousset instrumentation: long-term findings. Spine (Phila Pa 1976) 25:2333–2341

47.

Barr SJ, Schuette AM, Emans JB (1997) Lumbar pedicle screws versus hooks. Results in double major curves in adolescent idiopathic scoliosis. Spine 22:1369–1379CrossRef

48.

Benli IT, Akalin S, Aydin E, Baz A, Citak M, Kis M, Duman E (2001) Isola spinal instrumentation system for idiopathic scoliosis. Arch Orthop Trauma Surg 121:17–25CrossRef

49.

Papin P, Labelle H, Delorme S, Aubin CE, de Guise JA, Dansereau J (1999) Long-term three-dimensional changes of the spine after posterior spinal instrumentation and fusion in adolescent idiopathic scoliosis. Eur Spine J 8:16–21CrossRef

50.

Muschik M, Schlenzka D, Robinson PN, Kupferschmidt C (1999) Dorsal instrumentation for idiopathic adolescent thoracic scoliosis: rod rotation versus translation. Eur Spine J 8:93–99CrossRef

51.

Di Silvestre M, Bakaloudis G, Lolli F, Vommaro F, Martikos K, Parisini P (2008) Posterior fusion only for thoracic adolescent idiopathic scoliosis of more than 80 degrees: pedicle screws versus hybrid instrumentation. Eur Spine J 17:1336–1349CrossRef

Title: Use of the Universal Clamp in adolescent idiopathic scoliosis for deformity correction and as an adjunct to fusion: 2-year follow-up
Authors: Jérôme Sale de Gauzy
Jean-Luc Jouve
Franck Accadbled
Benjamin Blondel
Gérard Bollini
Publication date: 01-08-2011
Publisher: Springer Berlin Heidelberg
Published in: Journal of Children's Orthopaedics / Issue 4/2011
Print ISSN: 1863-2521
Electronic ISSN: 1863-2548
DOI: https://doi.org/10.1007/s11832-011-0357-z

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Use of the Universal Clamp in adolescent idiopathic scoliosis for deformity correction and as an adjunct to fusion: 2-year follow-up

Abstract

Purpose

Methods

Results

Conclusion

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Abstract

Purpose

Methods

Results

Conclusion

Please log in to get access to this content

Other articles of this Issue 4/2011

Elastic stable intramedullary nailing of tibial shaft fractures in children

Diagnosis and treatment of developmental dysplasia of the hip in the Netherlands: national questionnaire of paediatric orthopaedic surgeons on current practice in children less than 1 year old

A new surgical technique for the treatment of supracondylar humerus fracture malunions in children

Treatment of late-presenting developmental dislocation of the hip by progressive orthopaedic reduction and innominate osteotomy. Our results with more than 30 years of follow up

The role of postoperative furosemide therapy in the treatment of pleural effusion following kyphosis/scoliosis surgery

Upcoming Meetings and Courses