Comparison of hybrid constructs pedicle screws with sublaminar polyester bands versus pedicle screws only treatment of neuromuscular scoliosis

The choice of implants in neuromuscular scoliosis (NMS) surgery remains controversial. Sublaminar polyester bands (SPBs) seem to be a promising alternative implant. The purpose of current study was to compare clinical and radiological results of posterior instrumentation and fusion using hybrid constructs versus only pedicle screws for NMS treatment. In 24 patients, pedicle screws were used in all segments, and 18 patients underwent hybrid fixation. Cobb angle, thoracic kyphosis, lumbar lordosis angles, and pelvic obliquity were compared before and immediately after surgery, at the last follow-up radiographs. Demographic, clinical information, duration of surgery, estimated blood loss (EBL), blood transfusion, and complications were compared between groups. Additionally, patients were assessed for pain with visual analog scale (VAS) and quality of life with short Form 36 and Oswestry scale. Baseline characteristics of patients were similar except for EBL (p:0.002) and follow-up duration (p:0.004). The mean curve correction was 58.1% in hybrid group, and 67.6 % in screw group (p:0.07), and loss of correction was significantly lower in hybrid group (2.72±1.48° vs. 3.66±1.52°, p:0.049). Functional scores at final follow-up were equal in both groups (VAS p:0.865, Oswestry p:0.097 , SF-36 Physical p: 0.358, SF-36 Mental p:0.145). SPBs might be a better fixation alternative at the apex of rigid spinal deformity in NMS. The deformity can be corrected with less blood loss and at a similar rate of correction, with similar rate complications compared to pedicle screws.