How and When to Use Hooks to Improve Deformity Correction

Abstract

Hooks can play an important role in helping to achieve fixation during posterior spinal fusion (PSF) in patients with spinal deformity. This article reviews the different types of hooks used in PSF, advantages and disadvantages, indications, and multiple surgical techniques for insertion based on hook type. Key Concepts: • There are two types of down-going hooks: transverse process hooks and supralaminar hooks. There are also two types of up-going hooks: pedicle hooks, which can be seated laterally in the thoracic spine, and sublaminar hooks, which are more central. • Characteristic advantages of hooks are excellent cortical purchase for compression and distraction. Disadvantages of hooks include less three-dimensional control. • Indications for hook use include creating an adaptable upper transition, and an option for vertebrae with poorly developed or weakened pedicles. • Surgical techniques for hook insertion are specific for each type.