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World Neurosurg. 2018 Dec;120:e1136-e1142. doi: 10.1016/j.wneu.2018.08.244. Epub 2018 Sep 10.

Attenuation of Proximal Junctional Kyphosis Using Sublaminar Polyester Tension Bands: A Biomechanical Study.

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Department of Orthopedic Surgery, Icahn School of Medicine at Mount Sinai, New York, New York, USA. Electronic address:
Department of Orthopedic Surgery, Icahn School of Medicine at Mount Sinai, New York, New York, USA.
Zimmer Biomet Spine, Broomfield, Colorado, USA.



To investigate the effect of sublaminar polyester tension bands on the biomechanics of the motion segments proximal to a long fusion construct.


This was a human cadaveric biomechanical study. Pure moments of 4 Nm and 8 Nm were applied to the native spine and the instrumented spine, respectively (n = 8). The test conditions included native spine (T7-L2), fused (T10-L2), fused + bilateral tethers tensioned to 250 N at T9-T10 (tethers 250 N), fused + tethers tensioned to 350 N (tethers 350 N), fused (T11-L2) + tethers tensioned to 250 N at T9-T10 and 350 N at T10-T11 (2-level tethers), fused (T10-L2) + hand-tied suture loop through the spinous processes at T9-T10 (suture loop), and fused (T10-L2) with the T9-T10 interspinous and supraspinous ligaments cut (cut ISL/SSL).


The flexion range of motion (ROM) at T9-T10 of the fused spine, loaded at 8 Nm, increased to 162% of the native spine loaded at 4 Nm. The average flexion ROM at T9-T10 for tethers 250 N, tethers 350 N, 2-level tethers, suture loop, and cut ISL/SSL were 85% (P < 0.0001), 70% (P < 0.0001), 93% (P < 0.0001), 141% (P = 0.13), and 177% (P = 0.66) of the native spine at 4 Nm, respectively (P values vs. fused).


Sublaminar polyester bands can modulate the biomechanical flexion ROM as a function of the band pretension and provide a more consistent and tunable technique than hand-tying a suture loop between the spinous processes.


Adjacent-segment disease; Adult spine deformity; Biomechanics; Polyester tethers; Proximal junctional kyphosis; Tension band; Universal clamp

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