[Posterior operative correction of idiopathic scoliosis. Value of pedicle screws versus hooks]

Posterior correction and fusion of scoliosis with multisegmental instrumentation systems was developed by Cotrel-Dubousset in the 1980s. Initially correction and instrumentation was performed using hooks only. Later pedicle screws were implemented first for the lumbar and then for the thoracic spine. Nowadays instrumentation based on pedicle screws only is well established for posterior scoliosis surgery. Biomechanical studies demonstrated higher pull-out forces for pedicle than for hook constructs.In clinical studies several authors reported better Cobb angle correction of the primary and the secondary curves and less loss of correction in pedicle screw versus hook instrumentations. Furthermore, pedicle screw instrumentation allows fewer segments to be fused, especially caudally, and thus saving mobile segments. In most of these publications there were no differences in operation time, blood loss and complication rates. In summary, there is better curve correction without an increased risk using multisegmental pedicle screw instrumentation in modern posterior scoliosis surgery.