Prevention of Proximal Junctional Kyphosis & Failure Using Sublaminar Bands in a Hybrid Construct in Pediatric Kyphosis Deformity

A medical drawing of our preferred hybrid construct. The most rostral level (level 0) is instrumented with pedicle screws. A unilateral sublaminar band is then placed just caudal (level −1) to the upper instrumented vertebrae to allow for a smooth transition from the construct to the native spine. The next level caudal (level −2) is instrumented with bilateral pedicle screws. Next, another unilateral sublaminar band is placed at the next caudal level (level −3) usually on the contralateral side of the level −1 sublaminar band. Variations in anatomy allow for some individualization of sublaminar band utilization. We demonstrate one “family” of implant construct in this drawing, but also approve of bilateral sublaminar band use at the level –1 and level −3 positions if desired. Moreover, note the preservation of the interspinous ligament and facet joints at the proximal aspect of the construct in an attempt to prevent proximal junctional kyphosis.