Comparison of Cotrel-Dubousset pedicle screws and hooks in the treatment of idiopathic scoliosis

Suk, Se Il; Lee, Choon-Ki; Min, Hye Jeong; Cho, K. H.; Oh, Joo Han

doi:10.1007/bf00187077

Cited by 211 publications

(132 citation statements)

References 9 publications

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“…Transpedicular stabilization has become an established method for instrumentation of the thoracic and lumbar spine because of its immediate rigidity, better coronal and sagittal correction and shorter fusion length in scoliosis surgery when compared to the other instrumentation techniques [1,39]. Pedicle screw fixation of the thoracic spine is technically difficult with a high risk of potential complications such as neurologic, vascular and visceral injuries, associated with misplaced pedicle screws [7,8,12,15,16].…”

Section: Discussionmentioning

confidence: 99%

“…The initial use of pedicle screws began in the lumbar spine and as surgeons became more comfortable with the complex anatomy required for accurate screw placement, they evolved the use of pedicle instrumentation in thoracolumbar and thoracic spine [23,24,31]. Transpedicular screw fixation has many advantages over other spinal instrumentations such as Harrington rod fixation, Luque's instrumentation, etc., in various pathologies [1,27,31,39,45]. Pedicle screws also prevent the need to place instrumentation within the spinal canal like sublaminar wiring [6], which creates the risk of neurological injury.…”

Section: Introductionmentioning

confidence: 99%

“…Pedicle screws also prevent the need to place instrumentation within the spinal canal like sublaminar wiring [6], which creates the risk of neurological injury. When used in scoliosis surgery, transpedicular screws have been reported to enhance the operative correction [21,39].…”

Section: Introductionmentioning

confidence: 99%

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Accuracy and safety of pedicle screw placement in neuromuscular scoliosis with free-hand technique

et al. 2008

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It is a retrospective analytic study of 1,009 transpedicular screws (689 thoracic and 320 lumbosacral), inserted with free-hand technique in neuromuscular scoliosis using postoperative CT scan. The aim of paper was to determine the accuracy and safety of transpedicular screw placement with free-hand technique in neuromuscular scoliosis and to compare the accuracy at different levels in such population. All studies regarding accuracy and safety of pedicle screw in scoliosis represent idiopathic scoliosis using various techniques such as free-hand, navigation, image intensifier, etc., for screw insertion. Anatomies of vertebrae and pedicle are distorted in scoliosis, hence accurate and safe placement of pedicle screw is prerequisite for surgery. Between 2004 and 2006, 37 consecutive patients, average age 20 years (9-44 years), of neuromuscular scoliosis were operated with posterior pedicle screw fixation using free-hand technique. Accuracy of pedicle screws was studied on postoperative CT scan. Placement up to 2 mm medial side and 4 mm lateral side was considered within-safe zone. Of the 1,009 screws, 273 screws were displaced medially, laterally or on the anterior side showing that 73% screws (68% in thoracic and 82.5% in lumbar spine) were accurately placed within pedicle. Considering the safe zone, 93.3% (942/1009, 92.4% in thoracic and 95.3% in lumbar spine) of the screws were within the safe zone. Comparing accuracy according to severity of curve, accuracy was 75% in group 1 (curve \90°) and 69% in group 2 (curve [90°) with a safety of 94.8 and 91.2%, respectively (P = 0.35). Comparing the accuracy at different thoracic levels, it showed 67, 64 and 72% accuracy in upper, middle and lower thoracic levels with safety of 96.6, 89.2 and 93.1%, respectively, exhibiting no statistical significant difference (P = 0.17). Pedicle screw placement in neuromuscular scoliosis with free-hand technique is accurate and safe as other conditions.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Accuracy and safety of pedicle screw placement in neuromuscular scoliosis with free-hand technique

et al. 2008

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“…The implantation of pedicle screws with spinal instrumentation has shown to have improved coronal, sagittal and rotational deformity correction [2]. Because of the unique neurologic and vascular anatomy of the spinal canal and thoracic cavity, optimal screw placement is especially important for thoracic pedicle screws.…”

Section: Introductionmentioning

confidence: 99%

Use of computed tomographic reconstruction to establish the ideal entry point for pedicle screws in idiopathic scoliosis

Zhang²,

Peng

et al. 2011

Eur Spine J

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Objective To determine the ideal entry point for individual pedicle screw in the surgical treatment of idiopathic scoliosis using computed tomographic (CT) three-dimensional (3D) reconstruction. Methods Twenty patients with moderate or severe idiopathic scoliosis from two groups received surgical treatment using ''Free Hand technique'' and ''Assisted Free Hand technique''. Computed tomographic scanning with 3D reconstruction of the thoracic and lumbar spine was conducted to determine the entry point and to evaluate the placement accuracy. Results The accuracy of placement was 88.2% in convexity and 84.5% in concavity for the ''Free Hand'' group, and 94.1% in convexity and 94% in concavity for the ''Assisted Free Hand'' group. Evidence showed that ''Assisted Free Hand'' group had higher accuracy when screws were placed in the thoracic spine (P = 0.02), while no obvious difference was seen in the lumbar spine placement (P = 0.47). Conclusions We conclude that in the surgical treatment of severe scoliosis, individual screw placement guided by entry points determined by CT reconstruction can result in improved accuracy and ease of the procedure.

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“…Several reports have demonstrated that pedicle screws are superior for correcting scoliosis, in terms of the mean absolute degrees and percentage of curve correction, in comparison with posterior hook-and-wire or hybrid constructs [9][10][11]. Among the several surgical techniques available, pedicle screw instrumentation is considered to be reliable and safe [12][13][14], but clinical trials have reported a lordogenic effect with this form of posterior instrumentation [15][16][17].…”

Section: Introductionmentioning

confidence: 99%

Sagittal balance of thoracic lordoscoliosis: anterior dual rod instrumentation versus posterior pedicle screw fixation

et al. 2011

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Posterior pedicle screw fixation is now the standard treatment for surgical correction of idiopathic scoliosis and has largely replaced anterior techniques, but there have been reports describing a lordogenic effect of segmental pedicle screw instrumentation in the thoracic spine. This clinical study compared anterior dual rod instrumentation with posterior pedicle screw fixation for idiopathic thoracic lordoscoliosis, including 42 patients (7 male, 35 female; average age 16 years, range 12-34) who underwent posterior pedicle screw fixation (n = 20) or anterior dual rod instrumentation (n = 22) at two centers. The average follow-up period was 33 months (24-108 months). Inclusion criteria were a diagnosis of adolescent idiopathic scoliosis with a structural thoracic curve (Lenke 1-3) and thoracic hypokyphosis (T4-T12 \ 20°). The main thoracic curve magnitude and sagittal profile on standing radiographs were evaluated. Thoracic kyphosis was significantly restored from preoperatively 10.2°to 23.4°postoperatively in the anterior group and from 7.6°to 12.9°in the posterior group (P \ 0.005). Kyphosis improved significantly better in the anterior group than in the posterior group (P \ 0.005). The preoperative and postoperative main thoracic curve values were 63°(48-80°) and 25.2°in the anterior group and 60.6°(50-88°) and 23.6°in the posterior group, with no significant differences between the groups. No neurological or other severe complications were observed. Anterior dual rod instrumentation in patients with thoracic lordoscoliosis allows significantly better restoration of thoracic kyphosis than posterior pedicle screw instrumentation.

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Comparison of Cotrel-Dubousset pedicle screws and hooks in the treatment of idiopathic scoliosis

Cited by 211 publications

References 9 publications

Accuracy and safety of pedicle screw placement in neuromuscular scoliosis with free-hand technique

Accuracy and safety of pedicle screw placement in neuromuscular scoliosis with free-hand technique

Use of computed tomographic reconstruction to establish the ideal entry point for pedicle screws in idiopathic scoliosis

Sagittal balance of thoracic lordoscoliosis: anterior dual rod instrumentation versus posterior pedicle screw fixation

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