Peroperative Three-Dimensional Correction of Idiopathic Scoliosis With the Cotrel-Dubousset Procedure

Abstract

Study Design. 

A peroperative measurement technique based on magnetic fields was used to document the thoracic and lumbar vertebral changes induced by derotation of the concave rod during corrective surgery of idiopathic scoliotic deformities with Cotrel-Dubousset instrumentation.

Objectives. 

Objective was to accurately document the immediate changes induced by the derotation maneuver to gain a better understanding of its effect on curve correction during a surgical procedure.

Summary of Background Data. 

Accurate peroperative documentation of these three-dimensional changes was very limited, and the exact contribution of the derotation maneuver in the entire process of correction of a scoliotic deformity was still poorly understood.

Methods. 

A digitizer using magnetic fields was used to record the three-dimensional orientation and x, y, and z coordinates of the tip of every spinous process exposed at surgery before and after derotation of the concave rod in a group of 22 female patients with idiopathic scoliosis.

Results. 

A significant improvement of the scoliotic deformity was noted in the frontal plane, and improvement of thoracic hypokyphosis and lumbar hypolordosis in the sagittal plane was seen. Vertebral axial rotation remained unchanged.

Conclusions. 

The derotation maneuver is effective in achieving three-dimensional correction of idiopathic scoliosis, but vertebral axial derotation is not an important component of this correction.