Scoliosis - Surgery

Cotrel-Dubousset Procedure. The Cotrel-Dubousset procedure not only corrects the curve but may also help to correct rotation, and it does not cause flat back syndrome.

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With this procedure, parallel rods are cross-linked for better stability in holding the fused vertebrae. Improvement in correction averaged 66% in one study, with a later correction loss reported to be 5%. (Other studies have reported loss of curvature correction at less than 2%.) Over 95% of patients reported the results to be good or very good (only 86% of patients who had the Harrington procedure experienced the same levels of satisfaction). Patients often go home in five days and may be back in school in three weeks.

Complication rates are similar to the Harrington procedure, but there are some differences:

Operation time and blood loss are greater than with the Harrington procedure.
Cotrel-Dubousset and other procedures that are designed to reverse the rotation of the spine have less risk for flat back syndrome but they have a higher risk for spinal imbalance than the Harrington procedure.
Failure rates after 10 years are about 25%, which is very high. Experts hope that the advances in current scoliosis procedures will help reduce the long-term adverse effects.

The Texas Scottish-Rite Hospital (TSRH) Instrumentation. The Texas Scottish-Rite Hospital (TSRH) instrumentation is similar to the Cotrel-Dubousset procedure in that it uses parallel rods and other devices that reverse rotation as well as improve curvature. TSRH, however, uses smooth rods and hooks that are designed to make removal or adjustment easier later on if complications arise. Complications are similar to the Cotrel-Dubousset procedure.

Additional Forms of Instrumentation. Other instrumentation procedures have refined the hardware used in the Harrington and Cotrel-Dubousset operations.

Wisconsin segmental spine instrumentation (WSSI) may also be effective. It is as safe as the Harrington rod and nearly as strong as the Luque instrumentation.
Luque instrumentation was developed to help maintain normal lordosis and experts hoped that bracing would not be needed afterward with this device. A number of studies showed, however, that without braces, correction was lost after this operation, and there also may be a higher risk for spinal cord injury than with standard procedures. Luque instrumentation is used primarily in people whose scoliosis is due to problems of nerves and muscles, such as in children with cerebral palsy.
The Dorsal Dynamic Spondylodesis (DDS) system, under testing in Germany, is a semirigid system that allows for greater flexibility of the spine.