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Harrington-Luque and Cotrel-Dubousset instrumentation for idiopathic thoracic scoliosis. A postoperative comparison
A S Wojcik1, J K Webb, R G Burwell
1Harlow Wood Orthopaedic Hospital, Nottingham, England.
Insights
The Cotrel-Dubousset (CD) operation shows comparable results to the Harrington-Luque (HL) procedure for adolescent idiopathic thoracic scoliosis, with some advantages in specific spinal deformity corrections.
Area of Science:
- Orthopedics
- Spinal Surgery
- Pediatric Orthopedics
Background:
- Adolescent idiopathic thoracic scoliosis requires effective surgical interventions.
- Traditional spinal fusion techniques have varying degrees of success.
- Comparing newer and established surgical methods is crucial for treatment optimization.
Purpose of the Study:
- To compare the efficacy of the Cotrel-Dubousset (CD) operation versus the Harrington-Luque (HL) procedure.
- To evaluate radiographic outcomes in adolescent idiopathic thoracic scoliosis treatment.
- To identify specific advantages of each surgical technique.
Main Methods:
- Retrospective study of 39 patients with adolescent idiopathic thoracic scoliosis.
- Preoperative and postoperative segmental radiologic measurements.
- Analysis included Cobb angle, end-vertebra angles (EVAs), vertebral rotation, displacement, tilt, rib-vertebra angles (RVAs), kyphosis, and lordosis.
Main Results:
- CD and HL showed no significant difference in Cobb angle, flexibility index, apical displacement/rotation, apical RVAs, kyphosis, or lordosis.
- CD demonstrated superior correction of vertebral displacement at T10-11, lower thoracic EVA, and improved rotation/RVAs above the apex.
- Correction of vertebral tilt correlated with improved convex and concave RVAs.
Conclusions:
- The Cotrel-Dubousset operation offers specific advantages over the Harrington-Luque procedure in correcting certain thoracic spinal deformities.
- Further research is needed to evaluate the role of persistent rib deformity in surgical outcomes.
- Both CD and HL are viable options, with CD showing nuanced benefits.
Abstract:
This article reports a comparison of the Cotrel-Dubousset (CD) operation with the Harrington-Luque (HL) procedure for the treatment of adolescent idiopathic thoracic scoliosis. Thirty-nine patients were studied preoperatively and postoperatively using segmental radiologic measurements including Cobb angle, end-vertebra angles (EVAs), surgical flexibility index, vertebral rotation, displacement and tilt, convex and concave rib-vertebra angles (RVAs), and kyphosis and lordosis. Cotrel-Dubousset is not significantly different from HL with respect to Cobb angle (%), surgical flexibility index, apical vertebral displacement, apical vertebral rotation, apical rib-vertebra angles, kyphosis, and lordosis. It is significantly better than the HL with respect to the correction of vertebral displacement at T10-11; lower EVA of the thoracic curve; vertebral rotation mainly above the apex; convex RVAs above the apex; and concave RVAs at T10. The surgical correction of vertebral tilt above and below the apex of the thoracic curve is significantly related to the correction of convex and concave RVAs. The view that persistent deformity of ribs is a factor needing surgical correction in some patients with adolescent idiopathic thoracic scoliosis having posterior instrumentation and fusion needs further evaluation.