A comparison between the Cotrel-Dubousset and the pedicle screw-plate instrumentations in the adolescent idiopathic scoliosis.

Abstract

BACKGROUND: The Cotrel-Dubousset instrumentation (CD) is one of the standard instrumentations in the scoliosis surgery. Since the pedicle screw-plate system (PSP) was developed, it has resulted in the three-planar and three-dimensional correction with the minimal neurological complications. However, the correction effectiveness between these two methods is still open to question. OBJECTIVE: To compare the results of using the CD and the PSP in the treatment of adolescent idiopathic scoliosis. MATERIAL AND METHOD: A retrospective cohort study was conducted in all patients having an adolescent idiopathic scoliosis who underwent the surgery with either the CD or the PSP instrumentation at the Department of Orthopedics, Ramathibodi Hospital, during 1991 to 1998. The data of the Cobb angle, kyphotic angle, plumb line, rib hump difference and vertebral rotation were collected pre-operatively, post-operatively, and at the last follow-up. RESULTS: Forty-three patients having an adolescent idiopathic scoliosis were included. Eighteen patients: 16 females and 2 males were operated by the CD multiple hooks, and 25 patients: 23 females and 2 males were operated by the PSP instrumentation. The PSP system significantly reduced the Cobb angle and de-rotated the vertebrae in comparison with the CD group (p-value < or = 0.05). The percentage of the correction in King Type III, IV and T-L curve was higher than the other types. Both instrumentations could restore thoracic kyphosis without any major complications. CONCLUSION: The PSP system was more effective in the sagital correction, vertebral derotation and rib hump compared to the CD instrumentation. Although the PSD is a technically demanded operation, the PSP system is currently one of the most appropriate instrumentation for the adolescent idiopathic scoliosis treatment.