Results with Harrington system for scoliosis at 23-year follow-up finds most patients are still active

Issue: Issue 4 2009

VIENNA — The Harrington rodding system as a technique for correcting adolescent idiopathic scoliosis (AIS) curves failed to provide segmental and spinal rotation correction at long-term follow-up, but all of the patients included in the retrospective study were highly satisfied with how much function they still had years later.

Sven Ziegler, MD, of Stolzalpe, Austria, presented the findings at the 10th EFORT Congress, here.

Of the 74 patients he and his colleagues studied at about 23 years’ follow-up, 100% were satisfied with their current activities of daily living, 63% participated in sports and 92% were still working, he said.

“We think that newer actual methods have to prove after 25 years if they are as good as [the Harrington system],” Ziegler said.

Between 1968 to 1992, 256 patients with AIS were treated with Harrington instrumentation at the General and Orthopaedic Regional Hospital in Stolzalpe, where Ziegler works. His study included 74 of those patients with a mean follow-up of 22.5 years (48 women, 26 men).

The instrumentation only stopped being used worldwide during the past decade, he said.

Investigators assessed outcomes based on the Oswestry Disability Index (ODI) and Visual Analog Scale (VAS) scores and spine range of motion. They compared curve correction radiographically immediately postoperatively, at 1 year postop and at a minimum of one late follow-up time point.

At the last follow-up, mean ODI scores were 9 points (range, 1 to 12.5) and the average VAS score on the 10-point scale was 1.1 (range, 0 to 4). Patients reported problems sitting, standing and with what Ziegler described as “stress pain,” which occurred during activities like lifting weights.

According to the radiographic analysis Ziegler presented, one patient’s preoperative 55° scoliosis curve was measured at 38° at the latest follow-up, while another patient had a 68° curve that was corrected to 31° and remained steady over time. One woman had 34 years of follow-up results.

“There is no segmental correction and no correction of the rotation from the procedure, and you need a long bracing and orthosis therapy after the operation. … Despite that, we have very content patients who have no real restrictions in their activities of daily living,” Ziegler said.

In discussing the findings, one of the session’s moderators, Walter Strobl, MD, said, “You could show us that a very old method was quite well done. The literature has shown its advantages and your unit has benefited from the same results.”

Reference:
Ziegler S, Ivanic G, Loipur M, Pink T. Long-term results after Harrington operation in idiopathic scoliosis. Paper #637. Presented at the 10th EFORT Congress. June 3-6, 2009. Vienna.