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. 2022 Jul 25;16(6):977-982.
doi: 10.14444/8328. Online ahead of print.

Ultralong Follow-Up of Spinal Fusion for Adolescent Idiopathic Scoliosis: Harrington Instrumentation vs Uninstrumented Fusion

Peter Joo  1 , Noorullah Maqsoodi  1 , Aron Sulovari  1 , Adan Omar  1 , Jarren Section  1 , James Sanders  2 , Paul Rubery  1 , Emmanuel Menga  1 , Addisu Mesfin  3
Affiliations

Ultralong Follow-Up of Spinal Fusion for Adolescent Idiopathic Scoliosis: Harrington Instrumentation vs Uninstrumented Fusion

Peter Joo et al. Int J Spine Surg. .

Abstract

Background: Harrington instrumentation for adolescent idiopathic scoliosis (AIS) was revolutionary and allowed patients to mobilize faster as compared with patients treated with uninstrumented fusion. However, Harrington instrumentation provided correction of the deformity in 1 plane, resulting in limited sagittal plane control. Patients who received these 2 surgeries are aging, and to date, ultralong follow-up of these patients has not been reported.

Objective: The purpose of this study was to evaluate long-term patient-reported outcomes and radiographic parameters after Harrington nonsegmental distraction instrumentation vs uninstrumented fusion in the treatment of AIS.

Methods: Fourteen adult patients with AIS who were previously instrumented (n = 7) or uninstrumented (n = 7) were identified. Recent x-ray image measurements such as pelvic incidence (PI), sagittal vertical axis (SVA), pelvic tilt (PT), lumbar lordosis (LL), and pelvic incidence minus lumbar lordosis (PI-LL) were used to analyze deformities. Scoliosis Research Society-7 (SRS-7), Neck Disability Index (NDI), and Oswestry Disability Index (ODI) were used to evaluate patient-reported outcomes. Complications and rates of revision surgery were also evaluated.

Results: The mean age was 67.1 ± 5 years in the instrumented group and 64.1 ± 9 years in the uninstrumented group. There were no significant differences between instrumented and uninstrumented in SRS-7 (23.4 ± 2.9 vs 23.6 ± 2.6, P = 0.93), NDI (5.7 ± 4.5 vs 10.6 ± 4.5, P = 0.08), and ODI (9.7 ± 13.7 vs 9.4 ± 8.7, P = 0.99). Radiographic measurements of instrumented vs uninstrumented resulted in comparable PT (24.0 ± 7.9 vs 30.5 ± 4.7, P = 0.09), PI (61.3 ± 16.9 vs 67.2 ± 9.5, P = 0.47), LL (34.9 ± 14.4 vs 42.8 ± 11.0, P = 0.29), PI-LL (26.4 ± 25.1 vs 24.3 ± 10.4, P = 0.43), and SVA (38.1 ± 30.1 vs 52.3 ± 21.6, P = 0.37). There were 2 patients in the instrumented group who developed adjacent segment disease that required operative intervention compared with none in the uninstrumented group (P = 0.46).

Conclusion: In long-term follow-up of instrumented and uninstrumented fusion, patients had similar patient-reported outcomes and radiographic parameters, although the instrumented cohort had higher rates of adjacent segment disease.

Keywords: Harrington; deformity; nonsegmental distraction rod instrumentation; scoliosis surgery; spinal fusion; surgical outcome.

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Conflict of interest statement

Declaration of Conflicting Interests: Paul Rubery declares a grant from AO Spine. James Sanders declares grants from SRS and POSNA and consulting fees from Orthopaediatric. Emmanuel Menga declares a grant from Globus Medical, royalties from Evolution Spine, and consulting fees from Globus Medical. Addisu Mesfin declares grants from Globus Medical and AO Spine and consulting fees from Medtronic and DePuy Synthes. The remaining authors have no disclosures.

Figures

Figure 1
Figure 1
(A) Anterior-posterior and (B) lateral scoliosis radiographs of a 73-y-old woman 60 y after uninstrumented fusion for adolescent idiopathic scoliosis. Patient-reported outcomes demonstrated minimal pain/disability. NDI, Neck Disability Index; ODI, Oswestry Disability Index; SRS-7, Scoliosis Research Society-7.
Figure 2
Figure 2
(A) Anterior-posterior and (B) lateral scoliosis radiographs of a 69-y-old woman 57 y after instrumented fusion for adolescent idiopathic scoliosis. Patient-reported outcomes demonstrated minimal pain/disability. NDI, Neck Disability Index; ODI, Oswestry Disability Index; SRS-7, Scoliosis Research Society-7.
See this image and copyright information in PMC

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References

    1. Kouwenhoven J-W, Castelein RM. The pathogenesis of adolescent idiopathic scoliosis: review of the literature. Spine (Phila Pa 1976). 2008;33(26):2898–2908. 10.1097/BRS.0b013e3181891751 - DOI - PubMed
    1. Weinstein SL, Dolan LA, Cheng JCY, Danielsson A, Morcuende JA, et al. . Adolescent idiopathic scoliosis. Lancet. 2008;371(9623):1527–1537. 10.1016/S0140-6736(08)60658-3 - DOI - PubMed
    1. Parent S, Newton PO, Wenger DR. Adolescent idiopathic scoliosis: etiology, anatomy, natural history, and bracing. Instr Course Lect. 2005;54:529–536. - PubMed
    1. Hasler CC. A brief overview of 100 years of history of surgical treatment for adolescent idiopathic scoliosis. J Child Orthop. 2013;7(1):57–62. 10.1007/s11832-012-0466-3 - DOI - PMC - PubMed
    1. Goldstein LA. Results in the treatment of scoliosis with turnbuckle plaster cast correction and fusion. J Bone Joint Surg Am. 1959;41-A(2):321–335. - PubMed