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

We reviewed the outcome of patients who had been treated operatively for symptomatic peri-acetabular metastases and present an algorithm to guide treatment. . The records of 81 patients who had been treated operatively for symptomatic peri-acetabular metastases between 1987 and 2010 were identified. There were 27 men and 54 women with a mean age of 61 years (15 to 87). The diagnosis, size of lesion, degree of pelvic continuity, type of reconstruction, World Health Organization performance status, survival time, pain, mobility and complications including implant failure were recorded in each case. The overall patient survivorship at five years was 5%. The longest lived patient survived 16 years from the date of diagnosis. The mean survival was 23 months (< 1 to 16 years) and the median was 15 months. At follow-up 14 patients remained alive. Two cementoplasties failed because of local disease progression. Three Harrington rods broke: one patient needed a subsequent Girdlestone procedure. One ‘ice-cream cone’ prosthesis dislocated and was subsequently revised without further problems. We recommend the ‘ice-cream cone’ for pelvic discontinuity and Harrington rod reconstruction for severe bone loss. Smaller defects can be safely managed using standard revision hip techniques. Cite this article: Bone Joint J 2014;96-B:132–6

A modification of a previously reported one-stage technique for reduction and stabilisation of severe spondylolisthesis using a posterior route is described. Reduction is obtained by inserting Harrington rods to lift L5 vertically out of the pelvis and two double-threaded screws to pull it backwards. After reduction the rods are taken away and stabilisation achieved by means of screws and a sacral bar. With this modified technique lumbar vertebrae above L5 are never immobilised, compared with the previous method where the retention of the Harrington rods resulted in more lumbar vertebrae being immobilised than was necessary for fusion. Bone is resected from the sacrum and the fifth lumbar vertebra to avoid too much tension on the nerve roots. Bone grafts are not needed and lumbosacral fusion is achieved within six months due to close contact between the raw bone of the vertebral bodies. Three patients have been treated with this modified technique; there was no reslip, neither during the period when the metallic fixation was in situ nor after its removal

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

This prospective study was performed to determine the true incidence of deep vein thrombosis of the lower limb in children who had undergone halo-femoral traction to correct scoliosis before operation. Bilateral ascending phlebography of the lower limbs was performed on 54 children two days before spinal fusion and Harrington rod instrumentation. Two patients developed clinical evidence of thrombosis whilst on traction. This diagnosis was confirmed by phlebography. The other 52 children had no clinical evidence of thrombosis and their venograms were normal. The incidence of thrombosis was 3.7 per cent and clinically silent thrombosis did not occur

The operative and anaesthesic technique for 44 patients undergoing posterior spinal fusion with Harrington rod instrumentation for idiopathic scoliosis is described. There were two groups of 21 and 23 patients, matched for diagnosis and status before operation. The management of both groups was similar but in one group anaesthesia with induced hypotension was employed, using a mixture of sodium nitroprusside and trimetaphan. The mean blood loss at operation and after operation in this group was significantly lower than in the other group, with a consequent reduction in the transfusion requirement. No adverse sequelae were observed. All patients showed a drop in haemoglobin concentration after operation, despite clinically adequate blood transfusion

The results of the use of Harrington rods in the treatment of spinal fractures were reviewed. It was found that with burst fractures where the anterior pillar was deficient there was a significant incidence of loss of reduction. Anterior bone supplementation is recommended in these fractures when major loss of height or angulation occurs. Several technical faults were detected which, in most cases, also led to a loss of reduction. Almost all patients with an anatomical reduction were free of pain. There was no correlation between the loss of reduction and the lapse of time before operation, the levels of instrumentation, the length of the fusion, the severity of the initial deformity, the degree of initial correction or the presence or absence of a neurological deficit

1. Ten children with scoliosis and cerebral palsy of various types have been reviewed. All underwent operation for correction and stabilisation of the spinal curve, and spinal fusion. 2. Three of the ten patients required supplemental surgery in the form of regrafting, with or without reinsertion of Harrington rods. All have shown considerable correction of the curve, and in all cases the fusion appears to be consolidated. Operation has given these children stable spines which are compensated. Their ability to sit, and in some cases to stand, has improved. 3. In many such cases of scoliosis complicating cerebral palsy Harrington instrumentation and spinal fusion is the only feasible effective form of treatment

1. Twelve patients with suspected pseudarthroses in previous spine grafts were subjected to operation. 2. Correction of the curves was produced by Harrington's instrumentation at the sites of pseudarthroses, osteotomies and fractures. 3. A significant increase in stature was produced in all the patients. 4. Harrington's hooks were safely inserted into cavities cut in intact portions of previous grafts. 5. Most patients were able to leave hospital in less than four weeks. 6. Deliberate bending of the Harrington rods has not led to subsequent fracture of the rod. 7. A sliding scoliosis fusion frame is described. It reduces friction during correction and it reduces haemorrhage during surgery

Late-onset idiopathic scoliosis is associated with a rib hump in the thoracic region, and surgery is indicated when this deformity becomes unacceptable. Fifty patients with this deformity were treated by the Leeds procedure, which consists of segmental wiring to a kyphotically-contoured square-ended Harrington rod; this procedure not only derotates the spine but restores the natural thoracic kyphosis, thus avoiding subsequent buckling. All patients were followed up for a minimum of two years. Forty-two of these, who had a pre-operative Cobb angle of less than 60 degrees, were treated by one-stage instrumentation and fusion, while the remaining eight with greater curves underwent preliminary anterior multiple discectomy to provide flexibility with shortening. Postoperative loss of correction was not observed and there were no neurological complications

Adolescent idiopathic scoliosis in 152 patients was treated by Luque L-rod instrumentation and early mobilisation without external support. This series was compared with a matched group of 156 patients treated by Harrington instrumentation and immobilised in an underarm jacket for nine months. All the operations in both groups were performed by one surgeon and the patients were followed prospectively for more than two years. Correction of the scoliosis in the frontal plane was similar in both groups. However, the normal sagittal contour was better maintained with Luque rods, especially in the thoracolumbar and lumbar regions, and provided less loss of correction than with Harrington rods. Neither method significantly derotated the scoliosis. All the patients with Luque instrumentation developed a solid fusion despite breakage of the sublaminar wires at one or two levels in 4.9%. There were no major neurological complications with either type of instrumentation

1. The operation of spinal fusion combined with Harrington rod instrumentation is often accompanied by severe blood loss. Factors affecting the degree of blood loss are discussed with emphasis on the adverse effects of partial or complete obstruction of the inferior vena cava during operation. 2. A new scoliosis operating frame is described which is designed to encourage normal venous return during spinal fusion with the patient prone. In addition, it stabilises the patient during the procedure. 3. A standard anaesthetic technique and method of supporting the patient have been used in forty major corrective operations in thirty-eight consecutive cases of scoliosis in the past nine months. The measured blood loss at operation encountered in this series compares favourably with the quantities lost in a previously reported series of cases in which alternative methods of anaesthesia and of support for the patients were used. 4. All operations in both series were performed by the same surgeon (J. E. H.). Although further experience with the surgical technique has helped in reducing the blood loss in the later series, the same basic method of exposure and performance of the instrumentation and fusion has been used in all cases

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

Only a few studies have investigated the long-term health-related quality of life (HRQoL) in patients with an idiopathic scoliosis. The aim of this study was to investigate the overall HRQoL and employment status of patients with an idiopathic scoliosis 40 years after diagnosis, to compare it with that of the normal population, and to identify possible predictors for a better long-term HRQoL.

A prospective study to investigate changes in the rib hump or rib deformity after correction of the lateral curvature in adolescent idiopathic scoliosis is reported. The operative treatment for 47 patients was by a Harrington distraction rod and posterior fusion. Before operation and at follow-up, measurements of the Cobb angle, of vertebral rotation, and of the rib deformity were taken. Despite operative correction of the lateral curve, there was a progression of the rib deformity in 64% of the cases after four years. Correction of the lateral curve may thus have no effect on vertebral rotation and cannot be guaranteed to effect a permanent reduction of the rib hump

Aims

Hip reconstruction after resection of a periacetabular chondrosarcoma is complex and associated with a high rate of complications. Previous reports have compared no reconstruction with historical techniques that are no longer used. The aim of this study was to compare the results of tantalum acetabular reconstruction to both historical techniques and no reconstruction.

Aims

The outcome following the development of neurological complications after corrective surgery for scoliosis varies from full recovery to a permanent deficit. This study aimed to assess the prognosis and recovery of major neurological deficits in these patients, and to determine the risk factors for non-recovery, at a minimum follow-up of two years.