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Cotrel-Dubousset instrumentation. Results in 52 patients
K J Guidera1, J Hooten, W Weatherly
1Shriners Hospital for Crippled Children, Tampa, Florida.
Spine
|March 15, 1993
Summary
Cotrel-Dubousset instrumentation effectively corrects pediatric scoliosis, achieving significant curve reduction. While generally excellent, complications like rod breakage highlight the need for careful monitoring, especially in complex cases.
Area of Science:
- Orthopedics
- Spinal Surgery
- Pediatric Spine Deformities
Background:
- This study evaluates the efficacy and complications of Cotrel-Dubousset instrumentation in 52 pediatric patients undergoing posterior spinal fusion for idiopathic, congenital, and neuromuscular scoliosis.
- A subset of nine patients had undergone prior anterior spinal releases and fusions, indicating complex surgical histories.
Observation:
- The study included a mix of scoliotic curve patterns, predominantly right thoracic curvatures, with an average preoperative curve of 60.6 degrees.
- Postoperative correction averaged 29 degrees, with 17 patients requiring orthotic bracing and seven undergoing revision surgery.
Findings:
- Seventeen complications were reported, including hardware issues (hook pullout, prominent hardware, rod breakage) and infection, with two instances of fatigue failure in Cotrel-Dubousset rods secondary to pseudarthrosis.
- Increased operative morbidity and difficulty were noted in larger idiopathic curves and in patients with neuromuscular and congenital scoliosis.
Implications:
- Cotrel-Dubousset instrumentation demonstrates effectiveness in multiplanar correction of pediatric scoliosis and is suitable for revision procedures.
- The occurrence of fatigue failure in instrumentation, particularly when linked to pseudarthrosis, warrants further investigation and highlights potential long-term risks.