Does Hybrid Instrumentation Using Sublaminar Bands Give Comparable Results to All Pedicle Screw Constructs in Surgical Correction of Adolescent Idiopathic Scoliosis? A Systematic Review and Meta-Analysis of Current Evidence

AIM: To compare the results of surgical correction of adolescent idiopathic scoliosis (AIS) by posterior instrumentation using the conventional all pedicle screw fixation method (PS) and the hybrid fixation method utilising the sublaminar bands along with pedicle screws (HG). MATERIAL and METHODS: The study adheres to Preferred Reporting Items for Systematic reviews and Meta Analysis (PRISMA) and was registered with PROSPERO. This review included studies conducted on patients having AIS. All studies comparing the outcomes of PS with HG were included. RESULTS: We found an improvement of the main curve (p=0.007; SMD (IV, Random) = 0.54; 95% CI [0.15, 0.93]) in the PS group to be statistically significant. The two groups had statistically insignificant differences in the operative time, blood loss, number of levels fused, secondary curve correction and complication rates. We found PS had better outcomes in cases with preoperative hyperkyphosis whereas HG was better for patients with preoperative hypokyphosis. The complications on ling term follow up in the form of distal junctional kyphosis 2 years after surgery is higher in PS (5%). CONCLUSION: Hybrid constructs using sublaminar bands along with pedicle screws are safe and effective option for posterior instrumentation of AIS due to reduced incidence of complications like distal junctional kyphosis. They give better deformity correction in sagittal planes hence are more effective in restoring the dorsal kyphosis post-operatively.