Safety of sublaminar wires with Isola instrumentation for the treatment of idiopathic scoliosis

Study Design. To investigate the incidence of acute neurologic complications of use of sublaminar wires with third-generation spine instrumentation for the treatment bf idiopathic scoliosis. Objectives. To assess the safety of sublaminar wires in the surgical treatment of idiopathic scoliosis. Summary of Background Date. The use of sublaminar wires in spine deformity for neuromuscular scoliosis and the Luque system has been reported. Use of sublaminar wires is an integral part of the technique in the surgical treatment of spine deformity with Isola instrumentation (ACroMed, Cleveland, OH). To date, the safety of this technique has not been documented. Methods. The average age of the patients was 37 years (range,11-74 years). Preoperative diagnosis was adolescent idiopathic scoliosis in 75 patients and adult idiopathic scoliosis in 66. One hundred nine were primary surgeries, and 32 were revision. Detailed evaluation of the cu rye type, curve magnitude, number of vertebrae instrumented, level of Vertebrae wired, postoperative neurologic deficit, and the findings of intraoperative spinal cord monitoring was performed. Wires were always passed just before corrective maneuvers were performed. Results. A total of 1366 wires were placed, 65% (n = 888) in the thoracic region, 22% (n = 300) in the thoracolumbar, and 13% (n = 178) in the lumbar. No permanent change in intraoperative spinal cord monitoring was detected. Stagnara wake-up test was performed in ail patients. No patient with adolescent idiopathic scoliosis had neurologic complication. Two adults underwent revision surgery and had transient dysesthesia in the leg, which completely resolved with observation. Conclusion. Despite the increasing complexity of spinal instrumentation systems, sublaminar wire placement is a safe and useful adjunct in the surgical treatment of neurologically intact patients with idiopathic scoliosis.