Luque Instrumentation

The great advantage of segmental sublaminar wiring was its strength and the secure fixation it gave along the whole length of the curve. This made it especially valuable in neuromuscular scoliosis — the severe, often long, sweeping curves seen in children with conditions such as cerebral palsy or muscular dystrophy — where the bone can be soft and the curves difficult to hold. The strong, distributed grip of the Luque construct often allowed these children to be corrected and stabilised, sometimes without the need for a post-operative brace, which was a meaningful benefit for children who could not easily tolerate one.

The technique's central drawback was intrinsic to how it worked. Passing wires under the laminae means passing them through the spinal canal, immediately next to the spinal cord. This carried a recognised risk of neurological injury, and the literature of the era documented postoperative neurological deficits associated with segmental wiring, which is why spinal cord monitoring during surgery became so important. Large series quantified this risk. It was this hazard, together with the arrival of pedicle screws — which anchor into the vertebra from behind without entering the spinal canal and give even more powerful three-dimensional correction — that led surgeons to move away from sublaminar wiring for most purposes.

Luque instrumentation should be understood as a bridge. The Harrington rod corrected curves mainly by distraction from two points; Luque added segmental fixation and better control of the spine's contour, including a better ability to preserve the natural lumbar curve than distraction-based systems. Modern pedicle-screw constructs then combined the strength of segmental fixation with safer anchorage and superior correction in all planes. In that sense the lessons of Luque instrumentation are built into the systems used today, even though the wiring technique itself is now rarely used.

Many adults, particularly those treated for neuromuscular scoliosis in childhood, carry Luque constructs and are stable and well. If you have this instrumentation and develop new symptoms — increasing pain, change in posture, or neurological changes — that deserves assessment by a surgeon experienced in adult and revision deformity surgery. I do not use Luque instrumentation, and my purpose here is to explain the technique honestly and to signpost the right kind of specialist should you need one.

• —Luque ER. Clin Orthop Relat Res. 1982. Original description of segmental spinal instrumentation for scoliosis. PMID 7067252
• —Luque ER. Clin Orthop Relat Res. 1982. Paralytic scoliosis in growing children. PMID 7067255
• —Taddonio RF. Spine. 1982. Early series of segmental (Luque) instrumentation in neuromuscular deformity. PMID 7112245
• —Boachie-Adjei O, et al. J Bone Joint Surg Am. 1989. Management of neuromuscular deformities with Luque segmental instrumentation. PMID 2703515
• —Wilber RG, et al. J Bone Joint Surg Am. 1984. Postoperative neurological deficits in segmental instrumentation, with cord monitoring. PMID 6490694
• —Cervellati S, et al. Eur Spine J. 1996. Neurological complications in 750 segmental-instrumentation patients. PMID 8831117
• —Davies AG, et al. Spine. 1992. Luque-rod effect on lumbosacral sagittal contour. PMID 1536011
• —Hullin MG, et al. Spine. 1991. Effect of Luque segmental instrumentation on the rib hump in AIS. PMID 2047913
• —Osebold WR, et al. Spine. 1992. Variability of scoliotic-spine response to segmental instrumentation. PMID 1440006
• —Christodoulou AG, et al. Acta Orthop Scand Suppl. 1997. Luque rods with Hartshill rectangle, 2-6 year follow-up. PMID 9385255