Skip to main content
NCBI home page
The Iowa Orthopaedic Journal logoLink to The Iowa Orthopaedic Journal
. 1991;11:137–148.

The Use of Cotrel-Dubousset Instrumentation in the Treatment of Adult Idiopathic Scoliosis

John W Skubic, John P Kostuik, Paul B Suh, Paul Salo
PMCID: PMC2328958

Abstract

Between November 1985 and April 1988, forty-nine adults (forty-three females) underwent correction of their spinal deformity secondary to idiopathic scoliosis with Cotrel-Dubousset Instrumentation (CDI). Average age at the time of surgery was forty-three years (twenty-one to seventy-five years) with nineteen patients older than fifty years. Twelve patients had previous spinal fusions and nineteen patients required staged surgery. Follow up averaged thirty-four months (range twenty-four to fifty months). Average preoperative scoliosis was 60 degrees (range 26 to 115 degrees), and at final follow-up averaged 35 degrees (forty-two per cent correction). Previously unfused patients averaged 50 per cent correction. Sagittal curve correction was most dramatic in the hypokyphotic thoracic or hypolordotic lumbar spine, averaging 173 and 133 per cent improvement respectively. For lumbar curves especially, surgical technique depended on the flexibility of the curve, sagittal alignment, and on the need to fuse to the sacrum as determined by preoperative lumbosacral discography and pain reproduction. Twentyeight complications occurred in twenty patients. Loss of fixation due to lumbar lamina fracture and hook pull out occurred in four patients over age fifty who had a staged anterior release. Supplementing distal lumbar fixation with pedicle screws in this category of patients appears to be a viable solution. One nerve root neuropraxia attributable to the instrumentation resolved. Pain relief occurred in 82 per cent.

Full text

PDF
137

Images in this article

139Figures 1-A-B-C-D
on p.139
140Figures 2-A, 2-B, 2-C and 2-D
on p.140
140Figures 3-A, 3-B, 3-C and 3-D
on p.140
141Figures 4-A, 4-B, 4-C and 4-D
on p.141
141Figures 5-A, 5-B, 5-C and 5-D
on p.141
142Figures 6-A, 6-B, 6-C and 6-D
on p.142
144Figures 7-A, 7-B and 7-C
on p.144

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Allen B. L., Jr, Ferguson R. L. The Galveston technique for L rod instrumentation of the scoliotic spine. Spine (Phila Pa 1976) 1982 May-Jun;7(3):276–284. doi: 10.1097/00007632-198205000-00014. [DOI] [PubMed] [Google Scholar]
  2. Balderston R. A., Winter R. B., Moe J. H., Bradford D. S., Lonstein J. E. Fusion to the sacrum for nonparalytic scoliosis in the adult. Spine (Phila Pa 1976) 1986 Oct;11(8):824–829. doi: 10.1097/00007632-198610000-00017. [DOI] [PubMed] [Google Scholar]
  3. Casey M. P., Asher M. A., Jacobs R. R., Orrick J. M. The effect of Harrington rod contouring on lumbar lordosis. Spine (Phila Pa 1976) 1987 Oct;12(8):750–753. doi: 10.1097/00007632-198710000-00007. [DOI] [PubMed] [Google Scholar]
  4. Cochran T., Irstam L., Nachemson A. Long-term anatomic and functional changes in patients with adolescent idiopathic scoliosis treated by Harrington rod fusion. Spine (Phila Pa 1976) 1983 Sep;8(6):576–584. doi: 10.1097/00007632-198309000-00003. [DOI] [PubMed] [Google Scholar]
  5. Coe J. D., Becker P. S., McAfee P. C., Gurr K. R. Neuropathology with spinal instrumentation. J Orthop Res. 1989;7(3):359–370. doi: 10.1002/jor.1100070308. [DOI] [PubMed] [Google Scholar]
  6. Cotrel Y., Dubousset J., Guillaumat M. New universal instrumentation in spinal surgery. Clin Orthop Relat Res. 1988 Feb;227:10–23. [PubMed] [Google Scholar]
  7. Cummine J. L., Lonstein J. E., Moe J. H., Winter R. B., Bradford D. S. Reconstructive surgery in the adult for failed scoliosis fusion. J Bone Joint Surg Am. 1979 Dec;61(8):1151–1161. [PubMed] [Google Scholar]
  8. Denis F. Cotrel-Dubousset instrumentation in the treatment of idiopathic scoliosis. Orthop Clin North Am. 1988 Apr;19(2):291–311. [PubMed] [Google Scholar]
  9. Dwyer A. F. Experience of anterior correction of scoliosis. Clin Orthop Relat Res. 1973 Jun;(93):191–206. doi: 10.1097/00003086-197306000-00019. [DOI] [PubMed] [Google Scholar]
  10. Hall J. E. Dwyer Instrumentation in anterior fusion of the spine. J Bone Joint Surg Am. 1981 Sep;63(7):1188–1190. [PubMed] [Google Scholar]
  11. Harrington P. R., Dickson J. H. An eleven-year clinical investigation of Harrington instrumentation. A preliminary report on 578 cases. Clin Orthop Relat Res. 1973 Jun;(93):113–130. [PubMed] [Google Scholar]
  12. Hasday C. A., Passoff T. L., Perry J. Gait abnormalities arising from latrogenic loss of lumbar lordosis secondary to Harrington instrumentation in lumbar fractures. Spine (Phila Pa 1976) 1983 Jul-Aug;8(5):501–511. doi: 10.1097/00007632-198307000-00007. [DOI] [PubMed] [Google Scholar]
  13. Herring J. A., Wenger D. R. Segmental spinal instrumentation: a preliminary report of 40 consecutive cases. Spine (Phila Pa 1976) 1982 May-Jun;7(3):285–298. [PubMed] [Google Scholar]
  14. Johnson J. R., Holt R. T. Combined use of anterior and posterior surgery for adult scoliosis. Orthop Clin North Am. 1988 Apr;19(2):361–370. [PubMed] [Google Scholar]
  15. Johnston C. E., 2nd, Happel L. T., Jr, Norris R., Burke S. W., King A. G., Roberts J. M. Delayed paraplegia complicating sublaminar segmental spinal instrumentation. J Bone Joint Surg Am. 1986 Apr;68(4):556–563. [PubMed] [Google Scholar]
  16. Kostuik J. P., Carl A., Ferron S. Anterior Zielke instrumentation for spinal deformity in adults. J Bone Joint Surg Am. 1989 Jul;71(6):898–912. [PubMed] [Google Scholar]
  17. Kostuik J. P. Decision making in adult scoliosis. Spine (Phila Pa 1976) 1979 Nov-Dec;4(6):521–525. doi: 10.1097/00007632-197911000-00014. [DOI] [PubMed] [Google Scholar]
  18. Kostuik J. P., Hall B. B. Spinal fusions to the sacrum in adults with scoliosis. Spine (Phila Pa 1976) 1983 Jul-Aug;8(5):489–500. doi: 10.1097/00007632-198307000-00006. [DOI] [PubMed] [Google Scholar]
  19. Kostuik J. P., Maurais G. R., Richardson W. J., Okajima Y. Combined single stage anterior and posterior osteotomy for correction of iatrogenic lumbar kyphosis. Spine (Phila Pa 1976) 1988 Mar;13(3):257–266. doi: 10.1097/00007632-198803000-00007. [DOI] [PubMed] [Google Scholar]
  20. Kostuik J. P. Treatment of scoliosis in the adult thoracolumbar spine with special reference to fusion to the sacrum. Orthop Clin North Am. 1988 Apr;19(2):371–381. [PubMed] [Google Scholar]
  21. Luque E. R. The anatomic basis and development of segmental spinal instrumentation. Spine (Phila Pa 1976) 1982 May-Jun;7(3):256–259. doi: 10.1097/00007632-198205000-00010. [DOI] [PubMed] [Google Scholar]
  22. Moe J. H., Purcell G. A., Bradford D. S. Zielke instrumentation (VDS) for the correction of spinal curvature. Analysis of results in 66 patients. Clin Orthop Relat Res. 1983 Nov;(180):133–153. [PubMed] [Google Scholar]
  23. Ogiela D. M., Chan D. P. Ventral derotation spondylodesis. A review of 22 cases. Spine (Phila Pa 1976) 1986 Jan-Feb;11(1):18–22. doi: 10.1097/00007632-198601000-00005. [DOI] [PubMed] [Google Scholar]
  24. Sponseller P. D., Cohen M. S., Nachemson A. L., Hall J. E., Wohl M. E. Results of surgical treatment of adults with idiopathic scoliosis. J Bone Joint Surg Am. 1987 Jun;69(5):667–675. [PubMed] [Google Scholar]
  25. Swank S., Lonstein J. E., Moe J. H., Winter R. B., Bradford D. S. Surgical treatment of adult scoliosis. A review of two hundred and twenty-two cases. J Bone Joint Surg Am. 1981 Feb;63(2):268–287. [PubMed] [Google Scholar]
  26. Thompson G. H., Wilber R. G., Shaffer J. W., Scoles P. V., Nash C. L., Jr Segmental spinal instrumentation in idiopathic scoliosis. A preliminary report. Spine (Phila Pa 1976) 1985 Sep;10(7):623–630. doi: 10.1097/00007632-198509000-00006. [DOI] [PubMed] [Google Scholar]
  27. Wilber R. G., Thompson G. H., Shaffer J. W., Brown R. H., Nash C. L., Jr Postoperative neurological deficits in segmental spinal instrumentation. A study using spinal cord monitoring. J Bone Joint Surg Am. 1984 Oct;66(8):1178–1187. [PubMed] [Google Scholar]
  28. Winter R. B. Combined Dwyer and Harrington instrumentation and fusion in the treatment of selected patients with painful adult idiopathic scoliosis. Spine (Phila Pa 1976) 1978 Jun;3(2):135–141. doi: 10.1097/00007632-197806000-00007. [DOI] [PubMed] [Google Scholar]
  29. Winter R. B., Lonstein J. E., Denis F. Pain patterns in adult scoliosis. Orthop Clin North Am. 1988 Apr;19(2):339–345. [PubMed] [Google Scholar]
  30. Zielke K., Stunkat R., Beaujean F. Ventrale Derotationsspondylodese. Vorläufiger Ergebnisbericht über 26 operierte Fälle. Arch Orthop Unfallchir. 1976 Aug 19;85(3):257–277. doi: 10.1007/BF00415189. [DOI] [PubMed] [Google Scholar]
  31. van Dam B. E., Bradford D. S., Lonstein J. E., Moe J. H., Ogilvie J. W., Winter R. B. Adult idiopathic scoliosis treated by posterior spinal fusion and Harrington instrumentation. Spine (Phila Pa 1976) 1987 Jan-Feb;12(1):32–36. doi: 10.1097/00007632-198701000-00006. [DOI] [PubMed] [Google Scholar]
  32. van Dam B. E. Nonoperative treatment of adult scoliosis. Orthop Clin North Am. 1988 Apr;19(2):347–351. [PubMed] [Google Scholar]

Articles from The Iowa Orthopaedic Journal are provided here courtesy of The University of Iowa

RESOURCES