Long-Term Anatomic and Functional Changes in Patients with Adolescent Idiopathic Scoliosis Treated by Harrington Rod Fusion

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Abstract

One hundred patients from the Gothenburg Scoliosis Data Base were studied. They met the following criteria: (1) adolescent idiopathic scoliosis (2) completion of treatment before age 20, (3) a minimum follow-up of five years thereafter, (4) a minimum age of 22 years at final follow-up, and (5) operation performed by the senior author. Of these, 95 were personally examined. The surgical technique from 1968 to 1973 included a two-stage Harrington distraction, with fusion added at the second operation (52 patients). From 1973 to 1975, 48 patients were treated with a one-stage distraction and fusion after a week of preoperative Cotrel traction. Postoperatively, all patients were treated with a Milwaukee brace. A spinal examination and functional assessment, including a questionnaire and pain drawing, full standing anterior–posterior (AP), and lateral roentgenograms of the spine, was performed by independent observers. Eighty-five subjects without scoliosis served as a control group. The radiographic evaluation showed the usual nearly 50% permanent correction at the follow-up examination averaging nine years postoperatively. Lateral roentgenograms, however, demonstrated in 52% flattened or kyphotic cervical spines producing no significant complaints, non-significant flattening of the thoracic kyphosis, but significant lowering of the lumbar lordosis. Fifteen of the 24 patients with distal hook insertion and fusion including L4 or L5 demonstrated retrolisthesis. All had significant low-back pain. Degenerative facet joint changes and disc space narrowing was noted in 11 patients, again with a distal hook purchase in L4 or L5. Compared to the controls, the operated patients, as a group, revealed no lessened activity or back pain at any location. The operated patients, the majority (76%) cosmetically pleased, functioned at the same level as age-matched controls in regard to marriage, child-bearing, sports activities, and job performance. Although, as a group, the operated patients were functionally and socially very well indeed, low-back pain was found statistically significantly more often in patients in whom fusion was carried down to L4 or L5, compared to the control subjects.

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