A perspective review by Dubousset — co-developer of CD instrumentation — drawing on 55 years of pediatric spinal surgery experience. It traces technique evolution from non-instrumented casting through Harrington, Luque, and pedicle screw systems to the 1983 CD segmental 3D strategy. It then examines current growth-preserving approaches and argues against the modern race for maximum Cobb angle correction.
The instinct to maximize Cobb correction has driven pediatric spine surgery for decades, but Dubousset makes the case that this metric captures only the 'collapsing factor' of the spine — not its three-dimensional function.
The Cone of Economy reframes your operative goal: when planning fusion levels, the free disc spaces above and below the construct matter more than the residual curve in the fused block. Over-fusing to chase a lower Cobb number sacrifices the compensatory motion that enables long-term balance.
When you encounter a growing child with neuromuscular scoliosis and pelvic obliquity, iliosacral cannulated screws offer the most reliable pelvic anchor available. Zero pull-outs in over 200 cases, pseudarthrosis below 2%. If your program avoids them, it is likely because the screw trajectory is misunderstood, not because the technique is inferior.
For extended deformities in children under age 6-7, casting and bracing remain first-line. When surgery becomes necessary, the bipolar minimally invasive approach provides immediate stability without fusion or external bracing, preserving growth potential and potentially avoiding final fusion surgery altogether.
A perspective review by Dubousset — co-developer of CD instrumentation — drawing on 55 years of pediatric spinal surgery experience. It traces technique evolution from non-instrumented casting through Harrington, Luque, and pedicle screw systems to the 1983 CD segmental 3D strategy. It then examines current growth-preserving approaches and argues against the modern race for maximum Cobb angle correction.
The instinct to maximize Cobb correction has driven pediatric spine surgery for decades, but Dubousset makes the case that this metric captures only the 'collapsing factor' of the spine — not its three-dimensional function.
The Cone of Economy reframes your operative goal: when planning fusion levels, the free disc spaces above and below the construct matter more than the residual curve in the fused block. Over-fusing to chase a lower Cobb number sacrifices the compensatory motion that enables long-term balance.
When you encounter a growing child with neuromuscular scoliosis and pelvic obliquity, iliosacral cannulated screws offer the most reliable pelvic anchor available. Zero pull-outs in over 200 cases, pseudarthrosis below 2%. If your program avoids them, it is likely because the screw trajectory is misunderstood, not because the technique is inferior.
For extended deformities in children under age 6-7, casting and bracing remain first-line. When surgery becomes necessary, the bipolar minimally invasive approach provides immediate stability without fusion or external bracing, preserving growth potential and potentially avoiding final fusion surgery altogether.