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Sublaminar bands: are they safe?
E Polirsztok1, M Gavaret, T Gsell
1Pediatrics Orthopedic Surgery Department, AP-HM La Timone Children's Hospital, 264 rue Saint-Pierre, 13385, Marseille Cedex 5, France, evapolirsztok@gmail.com.
Summary
Sublaminar bands (SB) are safe for spine deviation correction in children and adolescents. Neurophysiologic alerts during SB placement are rare and comparable to other spinal implants, with minimal risk of neurological complications.
Area of Science:
- Spine surgery
- Pediatric orthopedics
- Neurosurgery
Background:
- Sublaminar bands (SB) are commonly used implants for correcting spinal deviations.
- Assessing the safety of SB in a large patient cohort is crucial for surgical practice.
Purpose of the Study:
- To evaluate the safety profile of sublaminar bands (SB) in a large series of pediatric patients undergoing spinal deviation correction.
- To determine the incidence and nature of neurophysiologic alerts associated with SB placement.
Main Methods:
- Retrospective analysis of 378 spinal deviation surgeries in children and adolescents using a hybrid posterior technique.
- Intraoperative neurophysiological monitoring, including somatosensory evoked potentials (SSEP) and neurogenic mixed evoked potentials (NMEP), was employed.
- Alerts defined as 50% amplitude decrease or 10% latency increase; data analyzed with statistical tests.
Main Results:
- 2,223 SB were used in 378 procedures, with ten neurophysiologic alerts during SB insertion.
- Alerts were associated with dysautonomic signs (hypertension, bradycardia); six SB were removed.
- A low rate of post-operative neurological deficiency (0.8%) was observed, with one incomplete recovery.
Conclusions:
- The neurological complication rate of SB is comparable to other spinal implants.
- Hemodynamic and neurophysiological changes during SB passage suggest a vegetative response.
- Safe and effective use of SB necessitates meticulous insertion technique to minimize trauma.
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