Modification of Cotrel-Dubousset's original hook constructs for idiopathicscoliosis

We performed a retrospective review of 41 patients (ages 9-18 years) who un derwent posterior spinal fusion with either Isola or Cotrel-Dubousset (CD) instrumentation to determine whether the presence of an apical hook on the thoracic convexity affected initial and long-term sagittal and coronal corr ection in adolescent idiopathic scoliosis surgery. A study group of 38 fema le and three male patients was evaluated (2-5 years of follow-up). Twenty-t hree patients (Group A) were treated with an up-going hook at the convex ap ex of the thoracic curve, and 18 patients (Group B) with similar curves wer e instrumented without an apical hook. Results showed that Group A's averag e preoperative coronal curve of 48 degrees decreased to 17 degrees, whereas Group B's preoperative average of 52 degrees decreased to 25 degrees. At f ollow-up, no statistical significance was noted in either coronal curve cor rection(p = 0.203) or sagittal kyphosis (p = 0.38) between Groups A and B. We conclude that omission of the up-going hook at the apex of the thoracic convexity can reduce postoperative discomfort in patients undergoing poster ior spinal fusion, without sacrificing curve correction or balance.