Revision Strategies for Harrington Rod Instrumentation: Radiographic Outcomes and Complications.

Abstract

Study design

Retrospective case series.

Objective

The purpose of this study is to evaluate the clinical and radiographic outcomes following revision surgery following Harrington rod instrumentation.

Methods

Patients who underwent revision surgery with a minimum of 1-year follow-up for flatback syndrome following Harrington rod instrumentation for adolescent idiopathic scoliosis were identified from a multicenter dataset. Baseline demographics and intraoperative information were obtained. Preoperative, initial postoperative, and most recent spinopelvic parameters were compared. Postoperative complications and reoperations were subsequently evaluated.

Results

A total of 41 patients met the inclusion criteria with an average follow-up of 27.7 months. Overall, 14 patients (34.1%) underwent a combined anterior-posterior fusion, and 27 (65.9%) underwent an osteotomy for correction. Preoperatively, the most common lower instrumented vertebra (LIV) was at L3 and L4 (61%), whereas 85% had a LIV to the pelvis after revision. The mean preoperative pelvic incidence-lumbar lordosis mismatch and C7 sagittal vertical axis were 23.7° and 89.6 mm. This was corrected to 8.1° and 28.9 mm and maintained to 9.04° and 34.4 mm at latest follow-up. Complications included deep wound infection (12.2%), durotomy (14.6%), implant related failures (14.6%), and temporary neurologic deficits (22.0%). Eight patients underwent further revision surgery at an average of 7.4 months after initial revision.

Conclusions

There are multiple surgical techniques to address symptomatic flatback syndrome in patients with previous Harrington rod instrumentation for adolescent idiopathic scoliosis. At an average of 27.7 months follow-up, pelvic incidence-lumbar lordosis mismatch and C7 sagittal vertical axis can be successfully corrected and maintained. However, complication and reoperation rates remain high.

Department

Description

Provenance

Citation

Published Version (Please cite this version)

10.1177/2192568220960759

Publication Info

Louie, Philip K, Sravisht Iyer, Krishn Khanna, Garrett K Harada, Alina Khalid, Munish Gupta, Douglas Burton, Christopher Shaffrey, et al. (2022). Revision Strategies for Harrington Rod Instrumentation: Radiographic Outcomes and Complications. Global spine journal, 12(4). pp. 654–662. 10.1177/2192568220960759 Retrieved from https://hdl.handle.net/10161/28019.

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