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Legacy Spinal Technologies
Cotrel-Dubousset Instrumentation
A historical overview of the Cotrel-Dubousset system, which introduced three-dimensional derotation correction of scoliosis and became the foundation of every modern deformity system. I do not use the original CD system; this page explains its lasting influence and the evidence.
Cotrel-Dubousset instrumentation, introduced in France in the 1980s, was one of the most influential developments in the history of scoliosis surgery. Where earlier systems corrected curves mainly by pulling the spine straight in one plane, the Cotrel-Dubousset — usually abbreviated to CD — system used multiple hooks and, later, screws attached to two rods, allowing the surgeon to rotate the rod and so correct the curve in three dimensions at once. This "derotation manoeuvre" changed how surgeons thought about scoliosis correction. I do not use the original CD system, which has been superseded by modern segmental screw constructs, but this page explains what it was, why it mattered so much, and what long-term follow-up shows.
For information only — not medical advice. The content on this page is patient education to help you understand a condition or treatment. It is not a substitute for personalised assessment by a qualified clinician. Always consult your doctor or specialist about your own symptoms, diagnosis, and treatment decisions.
What Cotrel-Dubousset instrumentation introduced
The key insight of the CD system was that scoliosis is not a simple sideways bend but a three-dimensional deformity, with rotation as well as curvature. By anchoring a contoured rod to the spine at many points with hooks, and then rotating the rod, the surgeon could translate a bent, rotated spine into a more normal shape — improving the sideways curve, the rotation, and the natural front-to-back curves together. It also allowed segmental fixation without passing wires through the spinal canal, avoiding one of the hazards of sublaminar wiring. This was a genuine conceptual leap, and the segmental, multi-anchor, rod-rotation approach it pioneered is the direct ancestor of every deformity system in use today.
What the evidence and long-term follow-up show
The CD system produced reliable, durable correction, and there is now long-term follow-up — out to 15 to 25 years in some series — showing that many patients maintained good correction and function. Studies comparing early hook-based constructs with later pedicle-screw versions documented the evolution toward the all-screw systems now standard. As with any powerful correction technique, complications were recognised: among them was decompensation, where correcting one part of the spine leaves the patient's overall balance slightly off, a problem that taught surgeons a great deal about planning correction across the whole spine rather than just at the main curve. Overall the evidence supports the CD system as an effective and important technique for its era.
How it shaped modern surgery
It is fair to say that modern scoliosis surgery is built on the foundations the Cotrel-Dubousset system laid. The progression from CD hooks, to CD screws, to the modern all-pedicle-screw constructs was a steady refinement of the same core ideas: segmental fixation, three-dimensional correction, and rod rotation. When patients are treated for scoliosis today, they are benefiting from principles this system introduced, even though the original hardware is no longer used.
What this means if you have CD instrumentation
Adults who had CD instrumentation for scoliosis in the 1980s or 1990s are often well and stable decades later. If you have this instrumentation and develop new back pain, a change in your posture or balance, or symptoms below the fused area, it is worth assessment by a surgeon who manages adult and revision deformity. I do not use the original CD system; this page is intended to give historical context and to point you toward the right specialist if you need one.
This page is for general education only and is not a substitute for personal medical advice. The original Cotrel-Dubousset system is historical and I do not perform it. Concerns about existing instrumentation should be assessed by a surgeon experienced in adult and revision spinal deformity.
Evidence & further reading
- —Cotrel Y, Dubousset J. Rev Chir Orthop Reparatrice Appar Mot. 1984. Original description of segmental posterior spinal osteosynthesis. PMID 6239334
- —Cotrel Y, et al. Clin Orthop Relat Res. 1988. Seminal paper: new universal instrumentation, introducing the derotation manoeuvre. PMID 3338200
- —Lavelle WF, et al. Scoliosis Spinal Disord. 2016. 15-25 year functional outcomes of posterior CD-type instrumentation. PMID 27551692
- —Boos N, et al. Iowa Orthop J. 2007. Long-term results of CD for right thoracic AIS. PMID 17907428
- —Lepsien U, et al. Z Orthop Ihre Grenzgeb. 2002. Long-term results of correction/fusion with CD instrumentation. PMID 11898069
- —Pucher A, et al. Ortop Traumatol Rehabil. 2005. Long-range outcomes of idiopathic scoliosis corrected with CD. PMID 17611468
- —Suk SI, et al. Int Orthop. 1994. CD pedicle screws vs hooks — step toward all-screw modern systems. PMID 7698863
- —Hopf CG, et al. Spine. 1997. CD-Hopf anterior spinal device — evolution of the CD system. PMID 9089934
- —Wajanavisit W, et al. J Med Assoc Thai. 2009. CD vs pedicle screw-plate instrumentation in AIS. PMID 19894336
- —Arlet V, et al. Eur Spine J. 2000. Decompensation after scoliosis surgery — a recognised complication. PMID 10823433
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