Cotrel-dubousset instrumentation in thoracolumbar seat belt-type and flexion-distraction injuries

For many years, all the internal fixation devices available for the surgical treatment of thoracolumbar fractures [Harrington rods (HR); Luque rods (LR); Hartshill rectangle (HTR); Roy Camille plates (RCP)] were not always able to distribute all the reductive strains (distraction, compression, derotation), or to guarantee solid stabilization without external supports. In some cases (with HR), only distraction forces might be applied, but stability of the assembly was very poor. Otherwise (with LR, HTR, or RCP), stability was well achieved using segmental fixation systems (with SSW, screws), but reduction was possible only by deflecting the spine towards the rods (or plates), by winging the sublaminar wires (or screws). Restoration of normal sagittal alignment was also very difficult to obtain. The use of internal fixation systems for reduction of thoracolumbar fractures when distraction or compression forces are needed are essential for the spinal surgeon and the patient. In some cases of thoracolumbar fractures (seat belt; flexion-distraction), in fact, the use of distraction forces is not suitable, leading only to overdistraction, not to reduction. The introduction of Cotrel-Dubousset instrumentation (CDI) in 1983, and its subsequent use in spinal traumatology, seems to answer all these unresolved questions.