Use of the Universal Clamp for deformity correction and as an adjunct to fusion: Preliminary results in scoliosis

Jouve, Jean-Luc; Gauzy, Jérôme Sales de; Blondel, Benjamin; Launay, Franck; Accadbled, Franck; Bollini, G.

doi:10.1007/s11832-009-0221-6

Cited by 24 publications

(22 citation statements)

References 46 publications

(90 reference statements)

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“…Those in which average preoperative thoracic kyphosis was [35.0°were excluded a T, Correction by translation; R, correction by rod rotation described by us in an earlier publication for the same cohort of patients [15]. The safety and efficacy of the initial report are confirmed by the 2-year follow-up data reported here.…”

Section: Discussionsupporting

confidence: 56%

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

Gauzy

Jouve

Accadbled

et al. 2011

Journal of Children's Orthopaedics

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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.

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Section: Discussionsupporting

confidence: 56%

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

Gauzy

Jouve

Accadbled

et al. 2011

Journal of Children's Orthopaedics

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“…It should be easier and safer to use in adults, especially in the lumbar spine where vertebrae are larger. Removal of a UC by section of the bands is straightforward [29] with no reported complications. Moreover, sublaminar polyethylene bands have been shown to have no adverse interactions with the dura [30] and several other groups have reported clinical use of soft sublaminar bands with no observed complications [31][32][33][34].…”

Section: Discussionmentioning

confidence: 96%

“…The main drawbacks of the UC techniques is the need for ligamentum flavum resection and potential neurological risk during the sublaminar insertion, although this complication has not been reported [9,11,28,29]. Neither of these implants can be used if decompressive laminectomy is required.…”

Section: Discussionmentioning

confidence: 99%

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Biomechanical evaluation of posterior lumbar dynamic stabilization: an in vitro comparison between Universal Clamp and Wallis systems

et al. 2010

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Treatment of chronic low back pain due to degenerative lumbar spine conditions often involves fusion of the symptomatic level. A known risk of this procedure is accelerated adjacent level degeneration. Motion preservation devices have been designed to provide stabilization to the symptomatic motion segment while preserving some physiologic motion. The aim of this study was to compare the changes in relative range of motion caused as a result of application of two non-fusion, dynamic stabilization devices: the Universal Clamp (UC) and the Wallis device. Nine fresh, frozen human lumbar spines (L1-Sacrum) were tested in flexion-extension, lateral bending, and axial rotation with a custom spine simulator. Specimens were tested in four conditions: (1) intact, (2) the Universal Clamp implanted at L3-4 (UC), (3) the UC with a transverse rod added (UCTR), and (4) the Wallis device implanted at L3-4. Total range of motion at 7.5 N-m was determined for each device and compared to intact condition. The UC device (with or without a transverse rod) restricted motion in all planes more than the Wallis. The greatest restriction was observed in flexion. The neutral position of the L3-4 motion segment shifted toward extension with the UC and UCTR. Motion at the adjacent levels remained similar to that observed in the intact spine for all three constructs. These results suggest that the UC device may be an appropriate dynamic stabilization device for degenerative lumbar disorders.

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“…Westrick and Ward [14] summarized the five main objectives in the surgical treatment of AIS: arrest deformity progression through a solid fusion, obtain a permanent correction of the deformity, improve appearance of the patient, improve functional outcomes and decrease the risk of degenerative disorders during adulthood.…”

Section: Discussionmentioning

confidence: 99%

Reciprocal sagittal alignment changes after posterior fusion in the setting of adolescent idiopathic scoliosis

et al. 2012

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Purpose Surgical adolescent idiopathic scoliosis (AIS) management can be associated with loss of thoracic kyphosis and a secondary loss of lumbar lordosis leading to iatrogenic flatback. Such conditions are associated with poorer clinical outcomes during adulthood. The aim of this study was to evaluate sagittal plane reciprocal changes after posterior spinal fusion in the setting of AIS. Methods Thirty consecutive adolescents (mean age 14.6 years) with AIS Lenke 1, 2 or 3 were included in this retrospective study with 2 year follow-up. Full-spine standing coronal and lateral radiographs were obtained preoperatively, at 3 and 24 months postoperatively. Coronal Cobb angle, thoracic kyphosis (TK) and lumbar lordosis (LL) were measured. Surgical procedure was similar in all the cases, with use of pedicular screws between T11 and the lowest instrumented vertebra (CL2), sublaminar hooks applied in compression at the upper thoracic level and sub-laminar bands and clamps in the concavity of the deformity. Statistical analysis was done using t test and Pearson correlation coefficient. Results Between preoperative and last follow-up evaluations a significant reduction of Cobb angle was observed (53.6°vs. 17.2°, p \ 0.001). A significant improvement of the instrumented thoracic kyphosis, TK (19.7°vs. 26.2°, p \ 0.005) was noted, without difference between 3 and 24 months postoperatively. An improvement in lumbar lordosis, LL (43.9°vs. 47.3°, p = 0.009) was also noted but occurred after the third postoperative month. A significant correlation was found between TK correction and improvement of LL (R = 0.382, p = 0.037), without correlation between these reciprocal changes and the amount of coronal correction. Conclusion Results from this study reveal that sagittal reciprocal changes occur after posterior fusion when TK is restored. These changes are visible after 3 months postoperatively, corresponding to a progressive adaptation of patient posture to the surgically induced alignment. These changes are not correlated with coronal plane correction of the deformity. In the setting of AIS, TK restoration is a critical goal and permits favorable postural adaptation. Further studies will include pelvic parameters and clinical scores in order to evaluate the impact of the noted reciprocal changes.

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Use of the Universal Clamp for deformity correction and as an adjunct to fusion: Preliminary results in scoliosis

Cited by 24 publications

References 46 publications

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

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

Biomechanical evaluation of posterior lumbar dynamic stabilization: an in vitro comparison between Universal Clamp and Wallis systems

Reciprocal sagittal alignment changes after posterior fusion in the setting of adolescent idiopathic scoliosis

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