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The Journal of Bone and Joint Surgery (American) 85:2303-2309 (2003)
© 2003 The Journal of Bone and Joint Surgery, Inc.

Harrington and Cotrel-Dubousset Instrumentation in Adolescent Idiopathic Scoliosis

Long-Term Functional and Radiographic Outcomes

Ilkka Helenius, MD, PhD1, Ville Remes, MD, PhD2, Timo Yrjönen, MD, PhD2, Mauno Ylikoski, MD, PhD2, Dietrich Schlenzka, MD, PhD2, Miia Helenius, DDS, BM2 and Mikko Poussa, MD, PhD2

1 Hospital for Children and Adolescents, Helsinki University Central Hospital, P.O. Box 281, Helsinki FIN-00029 HUS, Finland. E-mail address: ilkka.helenius{at}helsinki.fi
2 ORTON Orthopaedic Hospital, Invalid Foundation, Tenholantie 10, Helsinki FIN-00280, Finland

Investigation performed at ORTON Orthopaedic Hospital, Invalid Foundation, Helsinki, Finland

In support of their research or preparation of this manuscript, one or more of the authors received grants or outside funding from the Instrumentarium Scientific Foundation, Finnish Orthopaedic and Traumatology Foundation, Päivikki and Sakari Sohlberg Foundation, Emil Aaltonen Foundation, Juselius Foundation, The Foundation for Pediatric Research, and Sivia Kosti Foundation. None of the authors received payments or other benefits or a commitment or agreement to provide such benefits from a commercial entity. No commercial entity paid or directed, or agreed to pay or direct, any benefits to any research fund, foundation, educational institution, or other charitable or nonprofit organization with which the authors are affiliated or associated.

A commentary is available with the electronic versions of this article, on our web site (www.jbjs.org) and on our quarterly CD-ROM (call our subscription department, at 781-449-9780, to order the CD-ROM).

Background: Previous studies have shown that the long-term clinical outcome does not correlate with the radiographic outcome in patients treated with Harrington instrumentation for adolescent idiopathic scoliosis. Cotrel-Dubousset instrumentation has been reported to provide better correction radiographically, but it is unclear whether it provides better long-term clinical or functional outcomes. We are not aware of any long-term studies comparing Harrington and Cotrel-Dubousset instrumentation.

Methods: Seventy-eight patients in whom adolescent idiopathic scoliosis was treated with Harrington instrumentation and fifty-seven in whom it was treated with Cotrel-Dubousset instrumentation participated in this study. The mean duration of follow-up was 20.8 years for the Harrington instrumentation group and 13.0 years for the Cotrel-Dubousset instrumentation group. The mean age at the time of follow-up was thirty-six years and twenty-eight years, respectively. Radiographs were made preoperatively and at the two-year and final follow-up examinations. The Scoliosis Research Society questionnaire was completed, a physical examination was performed, and spinal mobility and non-dynamometric trunk strength were measured at the final follow-up visit.

Results: The mean preoperative Cobb angle of the thoracic curves was 53° in the Harrington instrumentation group and 55° in the Cotrel-Dubousset instrumentation group. The mean numbers of vertebrae included in the instrumentation were 10.7 and 9.9, respectively. At the two-year follow-up evaluation, the mean postoperative Cobb angles were 38° and 25°, respectively (p < 0.0001). At the final follow-up evaluation, the mean angles were 45° and 32° (p < 0.0001). No significant difference in thoracic kyphosis or lumbar lordosis was observed between the study groups at the final follow-up evaluation. The average score on the Scoliosis Research Society questionnaire was 97 points in both groups. Measurements of non-dynamometric trunk strength corresponded with age and sex-adjusted reference values, on the average, but patients with Cotrel-Dubousset instrumentation performed significantly better in the squatting test (p = 0.010). Abnormal lumbar extension and trunk side-bending were significantly more common in the Harrington instrumentation group (p = 0.050 and p = 0.0061, respectively). Complications were recorded for nine (12%) of the patients treated with Harrington instrumentation and fifteen (26%) of those treated with Cotrel-Dubousset instrumentation (p = 0.027).

Conclusions: Cotrel-Dubousset instrumentation yielded better long-term functional and radiographic outcomes in patients with adolescent idiopathic scoliosis than did Harrington instrumentation. However, complications were more common in the Cotrel-Dubousset instrumentation group.

Level of Evidence: Therapeutic study, Level III-2 (retrospective cohort study). See Instructions to Authors for a complete description of levels of evidence.


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Related articles in JBJS:

Harrington and Cotrel-Dubousset Instrumentation in Adolescent Idiopathic Scoliosis • I. Helenius and M. Poussa reply
Charles T. Price, Ilkka Helenius, and Mikko Poussa
JBJS 2004 86: 1828. [Extract] [Full Text]  



Letters to the Editor:

Read all Letters to the Editor

A Comparison of Harrington and Cotrel-Dubousset Instrumentation
Charles T. Price, M.D.
JBJS Online, 30 Dec 2003 [Full text]
Dr. Helenius and colleague respond
Ilkka Helenius, MD, PhD, et al.
JBJS Online, 30 Dec 2003 [Full text]