The Journal of Bone and Joint Surgery, Vol 63, Issue 4 608-619, Copyright © 1981 by Journal of Bone and Joint Surgery, Inc
Surgical treatment of congenital scoliosis with or without Harrington instrumentation
JE Hall, WA Herndon and CR Levine
Of thirty-one patients who underwent posterior fusion for congenital
scoliosis from 1972 through 1977 at the Children's Hospital Medical Center,
Boston, Massachusetts, and were followed for two years or more, eighteen
(average age, fourteen and one-half years and average curve, 62 degrees)
were treated by spine fusion using Harrington instrumentation, and thirteen
(average age, and one-half years and average curve, 43 degrees) were
treated by fusion without instrumentation. Correction of the curve in the
instrumented group was obtained at operation, while in the group without
instrumentation correction was attempted using a plaster jacket applied
during the postoperative period. After an average follow-up of thirty-four
months in the group with Harrington instrumentation, the average curve was
reduced from 62 to 40 degrees, for an average correction of 22 degrees,
while in the non-instrumented group, after an average follow-up of
fifty-three months the average curve was reduced from 43 to 38 degrees, for
an average correction 5 degrees. A myelogram using water-soluble contrast
medium should be performed in all patients who are to have instrumentation
and in all patients who have any neural abnormality or are suspected of
having diastematomyelia. An intraoperative wake-up test was used in all
patients who had instrumentation after 1973 and averted neural
complications in one. Proper treatment of congenital scoliosis requires
early recognition of curves that have already progressed or will certainly
do so. Fusion without instrumentation then is sufficient. If correction is
necessary, staged procedures (halo-femoral traction, anterior release, and
posterior fusion) may be required for severe curves. For the less severe
curves, instrumentation as the primary means of obtaining correction proved
to be safe and effective in this small series, but should only be attempted
by experienced surgeons in institutions with all of the necessary
facilities.
CiteULike 
Connotea 
Del.icio.us 
Technorati What's this?
