A new technic for segmental spinal osteosynthesis using the posterior approach.

The authors have designed a new method of instrumentation aimed at obtaining surgical fixation of the scoliotic curve without any postoperative external immobilisation. It is particularly strong and rigid and allows adequate reduction of the curve. This technique avoids the sublaminar space and thus prevents excessive blood loss and diminishes the danger of cord damage. The instrumentation is made of two parallel rough cylindrical rods inserted independently in the convexity and concavity of the curve. If necessary, they can be bent pre-operatively. They are attached to hooks placed on the laminae or pedicles, which are locked by bolts, thus allowing progressive straightening of the curve. They are joined by two transverse bars, one above and one below, to provide better rigidity to the device and to allow correction of rotation. The parts of the vertebrae left free by the device are denuded to allow the addition of grafts. Laboratory tests have demonstrated that this type of fixator is more rigid than the Harrington or Luque rods. Fifteen patients, either idiopathic or paralytic cases, were operated on without any neurological impairment. No loss of correction was observed since the hooks have been locked.

Application technique of Cotrel-Dubousset instrumentation for scoliosis deformities.

Used in over 600 cases, the posterior Cotrel-Dubousset spinal instrumentation device has become the device of choice. This technique allows the most effective correction for all kinds of spinal deformities. It requires lengthy preoperative planning and is a technically demanding surgical procedure; however, because of its versatility it can be adapted to most spinal deformities. The Cotrel- Dubousset technique is a rigid system of immobilization, and, because it does not require any postoperative immobilization, patients are able to resume their normal lives and activities very quickly.

[CD-instrumentation in the treatment of spinal deformities]. / Die CD-Instrumentation in der Behandlung von Wirbelsäulendeformitäten.

The development of CD-instrumentation aimed at corset-free postoperative patient management. Special attention was paid to a three-dimensional correction of spine deformities. Basic principles and implants are presented. After the description of the technique of implant fixation the surgical technique is presented with regard to the treatment of flexible thoracic lordo-scoliosis, rigid thoracic and thoraco-lumbar scoliosis. Finally, the basic principles in the treatment of kyphoses are discussed. The case material includes 150 patients who underwent surgery between 1983 and 1986.

New universal instrumentation in spinal surgery.

A new instrumentation for posterior spinal surgery consists of metallic rods carved with diamond-shaped asperities on which vertebral hooks or screws can be screwed in any position, level, or degree of rotation. The rods are interlocked by means of devices for transverse traction (DTTs), rectangular constructs with multiple vertebral grips, the stability of which allows suppression of any postoperative external support. Initially designed to treat scoliosis, this instrumentation design allows mobilization of the vertebrae located at the apex of the curve and obtains a three-dimensional correction. Correction of the areas of the most important structural deformation can also be obtained at the level of the end vertebrae, without any need to resort to an important distraction force. The technique varies according to the various types of curvatures. Approximately 250 patients were operated upon from 1983 to 1985. In idiopathic scoliotic curvatures, the mean percentage of correction was 66%. An important improvement of the associated sagittal deformations and of the apical derotation was observed in flexible curves. In paralytic curves, particularly with a pelvic obliquity, the percentage of correction of the frontal deformation is 77%. All of the spine patients were ambulatory in the first postoperative week, without any external support, and returned to their school or family activities. In 43 patients with follow-up periods longer than two years, there were no technical errors in 38. The final angular loss of correction was less than 2 degrees in the error-free group.

[A new technic for segmental spinal osteosynthesis using the posterior approach]. / Nouvelle technique d'ostéosynthèse rachidienne segmentaire par voie postérieure.

The authors have designed a new method of instrumentation aimed at obtaining a surgical fixation of the scoliotic curve without any post-operative external support. It is particularly strong and rigid and allows an adequate reduction of the curve. This technique avoids the sublaminar space and thus prevents excessive blood loss and diminishes the danger of cord damage. The instrumentation is made of two parallel rough cylindrical rods inserted independently in the convexity and the concavity of the curve. If necessary they can be bent pre-operatively. They are attached to hooks placed on the laminae or pedicles which are locked by bolts thus allowing progressive straightening of the curve. They are joined by two transverse bars, one above and one below to provide better rigidity to the device and allow correction of rotation. The parts of the vertebrae left free by the device are denuded to allow the addition of grafts. Laboratory tests have demonstrated that this type of fixator is more rigid than the Harrington or Luque rods. Fifteen patients, either idiopathic or paralytic cases were operated on without any neurological impairment. No loss of correction was observed since the hooks have been locked.