Forty-seven patients were treated with spinal fusion and Cotrel-Dubousset instrumentation and were followed for an average of 28 months. Spinal procedures included: 1) posterior spinal fusion for idiopathic scoliosis (26 patients); 2) posterior pseudarthrosis repair (5 patients); 3) combined anterior/posterior fusion to the sacrum (6 patients); and 4) combined anterior/posterior osteotomies (10 patients). Group 1: Partial derotational correction was achieved for adolescent idiopathic scoliosis. Group 2: Successful pseudarthrosis repair was achieved in four patients. Group 3: A solid arthrodesis was obtained in two patients, whereas the other three patients underwent revision of sacral screw fixation for pseudarthrosis. One patient died postoperatively. Group 4: Pain relief and a balanced correction was achieved in all patients. The Cotrel-Dubousset system appears to be a versatile system and provides a wide range of possibilities for a variety of spinal problems.