PT  - JOURNAL ARTICLE
AU  - BOGIE, R.
AU  - ARTS, J.J.
AU  - KOOLE, S.N.
AU  - VAN RHIJN, L.W.
AU  - WILLEMS, P.C.
TI  - The Use of Metal Sublaminar Wires in Modern Growth-Guidance Scoliosis Surgery: A Report of 4 Cases and Literature Review
AID  - 10.14444/7017
DP  - 2020 Apr 01
TA  - International Journal of Spine Surgery
PG  - 182--188
VI  - 14
IP  - 2
4099  - https://www.ijssurgery.com/content/14/2/182.short
4100  - https://www.ijssurgery.com/content/14/2/182.full
SO  - Int J Spine Surg2020 Apr 01; 14
AB  - Background: To avoid early fusion and allow residual growth of the spine in early onset scoliosis (EOS) treatment, growth-guided scoliosis surgery can be performed. Four patients with EOS are presented in which a growth-guidance instrumentation is used with sliding titanium (Ti) sublaminar cables. Residual growth of the spine can be preserved using metal sublaminar wiring; however, several drawbacks of this technique and type of material are illustrated.Methods: Four patients with progressive neuromuscular scoliosis were treated with a posterior stabilization. A fusionless growth-guidance instrumentation was used consisting of a combination of lumbar pedicle screws and sliding Ti sublaminar cables along cobalt chrome rods.Results: In 2 cases, the described growth-guidance technique provided sufficient stability and correction of the curvature with preservation of growth. In 2 patients, the instrumentation failed due to upper thoracic sublaminar wire breakage. The ongoing abrasion of the rod-wire interface caused severe metallosis. In these cases, a debridement and revision surgery was performed with partial fusion of the spine.Conclusions: Growth-guidance techniques with sliding metal sublaminar wires seem to be a valuable solution for the preservation of spinal growth in EOS surgery. High curvatures, however, have a higher chance of failure and demand for more corrective strength and support of the instrumentation. The use of metal sublaminar wires in a “sliding” instrumentation can lead to early breakage and metallosis.Level of Evidence: 4, case series.Clinical Relevance: Surgeons should be aware of possible complications associated with the use of metal laminar wires in spinal fusion and growth-guidance scoliosis surgery. The implementation of materials containing higher fatigue strength and lower friction properties (eg, UHMWPE wires) may avoid these potential complication risks.