Objective: To evaluate the long term radiological and clinical outcome after posterior correction of adolescent right thoracic idiopathic scoliosis with Cotrel-Dubousset instrumentation (CDI) and Harrington rod instrumentation (HRI). Design: Retrospective comparative analysis. Subjects: Out of preoperative standing radiographs of 229 patients 30 pairs of female patients, one patient with Harrington rod instrumentation (HRI) and the other with Cotrel-Dubousset instrumentation (CDI), could be identified. Curves within pairs were comparable with regard to curve magnitude (thoracic and lumbar) and level of stable and neutral vertebrae. Follow up examination included a clinical review, long cassette upright PA and lateral radiographs of the spine and two patient outcome questionnaires. Mean follow up time for CDI patients was 128 months and for HRI patients 198 months respectively. Outcome measures: The pain questionnaire according to Moskowitz [. 1. ] was used to assess back pain. A customized questionnaire was used to assess whether patients were satisfied with their postoperative cosmetic appearance. Results: In 92 per cent of the patients L2 was the lowest instrumented vertebra. The thoracic Cobb angle in the HRI group was corrected from 64° to 42° (34%) and in the CDI group from 66° to 24° (58%). Group differences were significant (p=0.004). The lumbar Cobb angle in the HRI group was corrected from 41° to 24° (41%) and in the CDI group from 44° to 21° (52%) respectively. Group differences were significant (p=0.03). The lumbar lordosis below the fusion could be improved postoperatively in CDI patients (L2–L5: 31° to 37°), whereas it remained unchanged in HRI patients (L2–L5: 32°). Group differences were significant (p=0.005). The overall cosmetic appearance was better in the CDI group (CDI 76% excellent and good, HRI 71%, p=0.04). 15% of the CDI patients and 24% of the HRI patients reported frequent low back pain episodes. Group differences were significant (p=0.008). A high correlation between incidence of low back pain and low degrees of lumbar lordosis below the fusion was revealed in HRI patients (p=0.02). Conclusion: With Cotrel-Dubousset instrumentation better correction of the thoracic and lumbar curves in the frontal plane and better restoration of the lumbar lordosis distal the fusion is achievable. The lack of restoration of lumbar lordosis below the fusion in HRI patients may have some impact on the higher incidence of low back pain episodes found in this group. The postoperative cosmetic result was better in patients with Cotrel-Dubousset instrumentation

The treatment of acetabular metastases with total hip arthroplasty is technically challenging often with significant loss of structural continuity in the medial wall and roof of the acetabulum, as described by Harrington in 1981 as class III defects. Traditionally the acetabular component is stabilised with Harrington rods but the risk of post-operative complications, especially bleeding is significant. We performed 10 consecutive total hip arthroplasties in patients with metastases involving the acetabulum with Harrington class III defects. The first three patients had acetabular reconstruction with a Kerboull cage, (Stryker Howmedica.) The cage was secured using a combination of screw fixation to the ileum and PMMA cement filling voids behind the cage. A polyethylene acetabular cup is then cemented into the cage. There was concern about the superior fixation using this implant and so the remaining 7 patients were treated using the Graft Augmentation Prosthesis (GAP II), (Stryker How-medica.) This is a titanium reconstruction cage with two superior flanges allowing extensive screw fixation onto the ileum. Two patients had very large defects where there was not sufficient support to use this cage alone, so the technique was augmented with Harrington rods. No implants have failed to date. One patient, an 83 year old female, died 23 days post-operatively after suffering a stroke. Two patients died of their disease 95 and 115 days after surgery. The remaining patients continue to have good pain and mobility following surgery as demonstrated by the Oxford hip score. We conclude that in suitable patients with extensive metastatic involvement of the acetabulum, a flanged acetabular reconstruction cage prosthesis is much improved way of providing support for a total hip replacement. This procedure can greatly improve quality of life, and to date we have had no mechanical failures of fixation using this technique

Introduction: A consecutive series of patients with adolescent idiopathic scoliosis (AIS), treated between 1968 and 1977 before 21 years of age, with distraction and fusion using Harrington rods (ST, n=156; 145 females and 11 males) were followed at least twenty years after completion of the treatment. Methods: One hundred and thirty-nine patients were reexamined as part of an unbiased personal follow-up, including a clinical examination, radiographs, validated questionnaires in terms of general and disease-specific quality of life aspects as well as present back and pain symptoms. An age- and sex-matched control group of 100 persons was randomly selected and subjected to the same examinations. Results: Curve size was mean 36 degrees and nine of the patients (6%) had undergone any additional curve-related surgical procedure due to complications. Significantly more patients complained of back pain (78%) in comparison to the control group (58%, p=0.0012), mainly lumbar but mild pain. Significant but numerically small differences could be found for Oswestry Disability Index but not for sociodemographic variables or general quality of life (SF-36) between the groups. No correlation could be found between pain and its localization and curve size, increase since end of treatment or curve type. No differences were found between patients fused to L3/higher versus L4/lower. Discussion and conclusion: Patients surgically treated for adolescent idiopathic scoliosis were found to have approximately the same quality of life and back function as the general population and only a few were physically severely disabled

Study Design: Thirty-four patients who were operated for spinal deformities with the Spine System Evolution (SSE) were retrospectively reviewed. Objectives: To evaluate the efficiency of SSE to correct spinal deformities. Summary of Background Data: Since the end of the Harrington rods era, several instrumentation were introduced for correction of spinal deformities. Most of these instrumentations are evolution of he CD instrumentation and are based on combination of translation, distraction/compression and possible some rotation forces. Cord injuries were informed to be more frequent with the new instruments and are related both to ischemic injuries and to mechanical insults to the cord by the supralaminar and the infralaminar hooks. Correction by the SSE is based on pedicle screws and pedicular-transverse locks. No hook is inserted into the spinal canal. Methods: All charts, radiographs, and images of the patients operated for spinal deformities with the SSE were reviewed. Thirty-four patients were found. For the purpose of this study they were evaluated for the amount of correction achieved, balance of the spine, subjective satisfaction of the cosmetic appearance and the surgical complications. Results: The mean age of the operated patients was 19.5 years. Twenty-one were operated for idiopathic scoliosis and were found to have 61% correction of the major curves. Five patients were operated for neuromuscular scoliosis with 69% of correction in average, four were operated for thoracic hyperkyphosis with reduction of the curves to physiologic range in all of them and four were operated for adult scoliosis with 38% of correction. Twenty-eight patients were satisfied from the results and the same number of patients were found to be balanced in the range of up to one-centimeter shift from the mid-line. No patient was found to have any major neurologic complication and no deep wound infections was registered. One patient had postoperative bronchopneumonia, another one had pneumothorax, one had superficial wound infection and another girl was troubled with her body image. Conclusions: SSE instrumentation was found friendly to use and relatively safe for correction of spinal deformities

Introduction: A consecutive series of patients with adolescent idiopathic scoliosis, treated between 1968 and 1977 before 21 years of age, either with distraction and fusion using Harrington rods (ST, n=156; 145 females and 11 males) or with brace (BT, n=127; 122 females and 5 males) were followed at least twenty years after completion of the treatment to determine the long-term outcome in terms of health related quality of life (HRQL) in patients treated for adolescent idiopathic scoliosis. No results on long term outcome of HRQL have previously been presented for this group of patients. Methods and Results: Ninety-four per cent of ST and 91% of BT patients filled in a questionnaire comprising the SF-36, Psychological General Well-Being Index (PGWB), Oswestry Disability Back Pain Questionnaire, parts of SRS/MODEM’s questionnaire and study-specific questions concerning the treatment, as a part of an unbiased personal follow-up examination. An age and sex-matched control group of 100 persons was randomly selected and subjected to the same examinations. There were no differences in terms of sociodemographic data between the groups. Both ST and BT patients had a slightly, but significantly reduced physical function using the SF-36 subscales, SF-36/Physical Component Summary (PCS) score as well as the Oswestry Disability Back Pain Questionnaire compared to the controls. Neither the mental subscales and the Mental Component Summary (MCS) score of SF-36 nor the PGWB index showed any significant difference between the groups. Forty-nine per cent of ST, 34% of BT and 15% of controls admitted limitation of social activities due to their back, (p< 0.001 ST vs. controls, BT vs. controls p= 0.010, and p=0.024 n.s. ST vs. BT), mostly due to difficulties to physically participate in activities or selfconsciousness about appearance. Pain was a minor reason for limitation. No correlation could be found between the outcome scores and curve size after treatment, curve type, total treatment time or age at completed treatment. Conclusions: Patients treated for adolescent idiopathic scoliosis were found to have approximately the same HRQL as the general population. A minority of the patients (4%) had a severely decreased psychological well-being and a few (1.5%) were physically severely disabled due to the back

This study was undertaken to evaluate the efficacy and reliability of posterior intra-operative reduction and fusion by pedicle screw fixation in the treatment of children and adolescents for severe lumbosacral spondy-lolisthesis.Researchers identified 21 patients who underwent reduction of their high-grade spondylolisthesis at our Institution between 1993 and 2000. Recent clinical and radiograph data were available for all patients. Indications for surgery were severe back pain in 21 patients, leg pain in 17, cosmetic appearance in 16 and progression of slippage in 15. There were 11 females and 10 males, aged 16 years on average (range, 11–18 years). Seven patients had grade III slippage, nine grade IV and five grade V. The slippage was at L4-L5 level in one patient and at L5-S1 in the remaining cases. The instrumented levels were 2 (L4-S1) in 12 patients and 1 in nine (L5-S1). The patients underwent surgery using a single posterior surgical procedure. After removal of the loosened arch and complete discectomy, gradual distraction and posterior translation of the anteriorly displaced vertebral body were performed using a temporary device (Harrington rod) placed bilaterally between L1 and the sacral wings. Reduction was followed by a posterior interbody strut graft or placement of titanium cages and pedicle segmental fixation. At a mean follow-up of 5 years (range, 1–10 years) a complete remission of back pain was observed in 18 cases and incomplete in three; all presented solid fusion radiographically. The mean correction of the slippage was 33.1%.(from 78.3% to 41%) and that of the slippage angle 51% (from 35.2° to 17°). Complications included two skin protrusions of a sacral screw, two transitory neurological deficit (L5-S1). Two patients with screw pullout underwent instrumentation revision and reinsertion of screws; another two patients underwent anterior interbody fusion since slippage exceeded 50% after posterior reduction. Reduction of high-grade spondylolisthesis may be considered for patients with a high degree of lumbosacral kyphosis, an unacceptable clinical appearance, and/or neurological deficit. With the advent of pedicle screw fixation, posterior instrumentation and reduction appears feasible. We found that using the gradual reduction by temporary Harrington rod incurs less risk than other options for treating high-grade spondylolisthesis. This procedure provides a controlled method of reduction where continuous visualisation of nerve roots is possible and internal fixation is achieved

Aims

Magnetically controlled growing rods (MCGR) have been gaining popularity in the management of early-onset scoliosis (EOS) over the past decade. We present our experience with the first 44 MCGR consecutive cases treated at our institution.