Revision Strategies for Harrington Rod Instrumentation: Radiographic Outcomes and Complications. Academic Article uri icon

Overview

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.

authors

  • Louie, Philip K
  • Iyer, Sravisht
  • Khanna, Krishn
  • Harada, Garrett K
  • Khalid, Alina
  • Gupta, Munish
  • Burton, Douglas
  • Shaffrey, Christopher
  • Lafage, Renaud
  • Lafage, Virginie
  • Dewald, Christopher J
  • Schwab, Frank J
  • Kim, Han Jo

publication date

  • October 1, 2020

Identity

PubMed Central ID

  • PMC9109553

Scopus Document Identifier

  • 85091757310

Digital Object Identifier (DOI)

  • 10.1177/2192568220960759

PubMed ID

  • 33000651

Additional Document Info

volume

  • 12

issue

  • 4