Lg. Lenke et al., ABILITY OF COTREL-DUBOUSSET INSTRUMENTATION TO PRESERVE DISTAL LUMBARMOTION SEGMENTS IN ADOLESCENT IDIOPATHIC SCOLIOSIS, Journal of spinal disorders, 6(4), 1993, pp. 339-350
Between 1985 and 1990,44 patients with adolescent idiopathic scoliosis
were treated with Cotrel-Dubousset instrumentation when Harrington in
strumentation would have extended into the distal lumbar spine (L3, L4
, or L5) for these curve patterns. Twenty-four of these 44 (group 1) p
atients had one distal fusion level preserved using Cotrel-Dubousset i
nstrumentation, whereas the other 20 patients (group II) were instrume
nted/fused with Cotrel-Dubousset instrumentation to the expected Harri
ngton instrumentation level in the lower lumbar spine. All patients ha
ve a minimum 2-year follow-up, and the average follow-up is 39 months
(range 24-74). The characteristics of the group I curves that allowed
us to stop the instrumentation a level short included minimal rotation
and tilt of the anticipated lowest instrumented vertebra, overall cor
onal curve flexibility, and nonstructural components to the lumbosacra
l region of the spine. There were no major differences between these t
wo groups when comparing postoperative coronal and sagittal balance pa
rameters at the most recent follow-up. In select cases, dependent on t
he preoperative criteria to be discussed, Cotrel-Dubousset instrumenta
tion (vs. traditional Harrington instrumentation) does allow distal lu
mbar fusion levels to be saved while maintaining acceptable coronal an
d sagittal balance.