Resident Physician University of Pittsburgh Medical Center Pittsburgh, Pennsylvania, United States
Introduction: Harrington rods were frequently used for operative management of adolescent idiopathic scoliosis circa 1960s to 1980s. Although initial long-term outcomes were promising, some patients developed progressive scoliosis, flatback syndrome, pain, and/or neurological deficits, which may warrant revision operations in select cases. As such, the objective of this study was to report outcomes and complications associated with adult spinal deformity surgery in patients previously treated with Harrington rods.
Methods: We reviewed a single-center operative database to identify patients with Harrington rods who underwent index adult spinal deformity surgery between 2008 and 2022. Demographics, operative characteristics, radiographic spinal alignment, health-related quality-of-life (HRQL), and complications were analyzed.
Results: A total of 17 consecutive patients were included (mean age 53±7.64 years old, 77% women). The surgery was anterior-only and posterior-only in 2 (11%) and 15 (89%) patients, respectively. The mean instrumentation length in the posterior-only cohort was 7±3.2 instrumented levels with 13 (86%) patients having pelvic fixation. Pelvic incidence-lumbar lordosis mismatch was corrected 24.0±21.0° to 12.6±33.8°, but pelvic tilt remained unchanged from 26.2±11.8° to 26.7±13.7°. Global sagittal balance was corrected from 61.4±34.0 to 43.6±33.0. Preoperative major thoracolumbar/lumbar (TL/L) remained unchanged from 44.3±19.2 to 44.9±17.9 however lumbosacral fractional (L4-S1) curves were corrected from 10.8±8.6 to 7.4±7.9. Oswestry Disability Index and Visual Analog Scale-back pain improved postoperatively from 47.8±18.9 to 25.1±24.2 and 6.5±2.5 to 4.2±2.9 at time of last follow-up. Complications included wound infection (11.7%), rod fractures (17.6%), and neurological deficits (5.8%) with 5 patients requiring revision surgery.
Conclusion : Patients with Harrington rods who later present with symptoms warranting revision spine surgery can present unique technical challenges. In this single-center series, our results demonstrated radiographic sagittal correction, improved HRQL, and high complication/revision rates. Until further large prospective studies are performed, our results may be interpreted as preliminary evidence to suggest good outcomes are possible in this challenging subset of adult spinal deformity patients.
