Sublaminar cables in cervical stabilization

Posterior cervical fusion with sublaminar cables is indicated in the presence of bony weakness (e.g. osteoporosis) with intact lamina due to high pullout strength. In other situations cables may be preferable to plates or hooks, as when distorted anatomy hinders their placement. Sublaminar cables are more rigid than wires and multistranded varieties carry less risk of dural/spinal injury. They are particularly useful at the cervicothoracic and atlantoaxial junctions.

Placement begins with the patient lying prone under general anesthesia. Midline incision and subperiosteal dissection are performed, exposing the lamina to the facet joints on either side. The ligamentum flavum is removed and cable passed beneath the lamina one segment at a time, caudal to rostral. Cables are folded on themselves into a long loop and pulled out by the curved segment using a nerve hook. This leading curve is then cut, leaving one strand of cable under each side of the lamina. Once every segment has been instrumented the cables are attached to rods bilaterally, tightened, and stabilized with a crossbar. Fusion is performed on decorticated lamina and spinous processes using various substrates, including autograft, allograft, and/or BMP.

To promote fusion and stabilize the neck a rigid collar should be worn for twelve weeks. NSAIDs and corticosteroids should be avoided. Before discharging the orthosis, flexion/extension films should be evaluated for instability.

References

1. Songer MN, Spencer DL, Meyer PR Jr, Jayaraman G. The use of sublaminar cables to replace Luque wires. Spine. 1991 Aug;16(8 Suppl):S418-21.

2. Weis JC, Cunningham BW, Kanayama M, Parker L, McAfee PC. In vitro biomechanical comparison of multistrand cables with conventional cervical stabilization. Spine. 1996 Sep 15;21(18):2108-14.