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Revision of Harrington rod constructs: a single-center’s experience with this homogenous adult spinal deformity population at a minimum 2-year follow-up

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Abstract

Purpose

To evaluate radiographic and clinical outcomes following revision surgery after HRC fusions.

Methods

Single-institution, retrospective study of patients revised following HRC with minimum 2-year follow-up post-revision. Demographics, perioperative information, radiographic parameters, complications, and Oswestry disability index (ODI) scores were collected. Radiographic parameters included global alignment, coronal and sagittal measurements pre and postoperatively, as well as final follow-up time points.

Results

26 patients were included with a mean follow-up of 3.3 ± 1.1 years. Mean age was 55.5 ± 7.8 years, BMI 25.2 ± 5.8, and 22 (85%) were females. Instrumented levels increased from 9.7 ± 2.8 to 16.0 ± 2.2. Five (19.2%) patients underwent lumbar pedicle subtraction osteotomies, and 23 (88.4%) had interbody fusions. Patients significantly improved in all radiographic parameters at immediate and final follow-up (p < 0.005), except for thoracic kyphosis and pelvic incidence (p > 0.05). Correction was maintained from immediate postop to final follow-up (p > 0.05). 20 (76.9%) of patients experienced a complication at some point within the follow-up period with the most common being a lumbar nerve root deficit (n = 7). However, only one patient had a nerve root deficit at final follow-up, that being a 4/5 unilateral anterior tibialis function. 5 (19.2%) patients required further revision within a mean of 1.8 ± 1.1 years. On average, patients had an improvement in ODI score by final follow-up (35.6 ± 16.8 vs 25.4 ± 19.8, p = 0.035).

Conclusion

Patients revised for HRCs significantly improve, both clinically and radiographically by final follow-up. This group did have a propensity for distal lumbar root neurological issues, which were common but all patients except for one, recovered to full strength by two-year follow-up.

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Data availability

Data is not publically available but available upon request.

References

  1. Hibbs RA (2007) An operation for progressive spinal deformities: a preliminary report of three cases from the service of the orthopaedic hospital. 1911. Clin Orthop Relat Res 460:17–20 (published Online First: Epub Date)

    Article  PubMed  Google Scholar 

  2. Harrington PR (2002) Treatment of scoliosis: correction and internal fixation by spine instrumentation. June 1962. J Bone Joint Surg Am 84(2):316

    Article  PubMed  Google Scholar 

  3. Cochran T, Irstam L, Nachemson A (1983) Long-term anatomic and functional changes in patients with adolescent idiopathic scoliosis treated by Harrington rod fusion. Spine (Phila Pa 1976) 8(6):576–84 (published Online First: Epub Date)

    Article  CAS  PubMed  Google Scholar 

  4. Mariconda M, Galasso O, Barca P, Milano C (2005) Minimum 20-year follow-up results of Harrington rod fusion for idiopathic scoliosis. Eur Spine J 14(9):854–61 (published Online First: Epub Date)

    Article  CAS  PubMed  Google Scholar 

  5. Dickson JH, Erwin WD, Rossi D (1990) Harrington instrumentation and arthrodesis for idiopathic scoliosis. a twenty-one-year follow-up. J Bone Joint Surg Am 72(5):678–83

    Article  CAS  PubMed  Google Scholar 

  6. Potter BK, Lenke LG, Kuklo TR (2004) Prevention and management of iatrogenic flatback deformity. J Bone Joint Surg Am 86(8):1793–808 (published Online First: Epub Date)

    Article  PubMed  Google Scholar 

  7. Wiggins GC, Ondra SL, Shaffrey CI (2003) Management of iatrogenic flat-back syndrome. Neurosurg Focus 15(3):E8 (published Online First: Epub Date)

    Article  PubMed  Google Scholar 

  8. Swank SM, Mauri TM, Brown JC (1990) The lumbar lordosis below Harrington instrumentation for scoliosis. Spine (Phila Pa 1976) 15(3):181–6 (published Online First: Epub Date)

    Article  CAS  PubMed  Google Scholar 

  9. Marino MA, Scaglia M, Pasquetto D, Sambugaro E, Tromponi C, Magnan B (2016) Two cases of failed back surgery syndrome after correction and stabilization surgery for scoliosis with Harrington instrumentation. Acta Biomed 87(Suppl 1):112–115

    PubMed  Google Scholar 

  10. Liu N, Wood KB (2017) Multiple-hook fixation in revision spinal deformity surgery for patients with a previous multilevel fusion mass: technical note and preliminary outcomes. J Neurosurg Spine 26(3):368–73 (published Online First: Epub Date)

    Article  PubMed  Google Scholar 

  11. Louie PK, Iyer S, Khanna K et al (2022) Revision strategies for Harrington rod instrumentation: radiographic outcomes and complications. Global Spine J 12(4):654–62 (published Online First: Epub Date)

    Article  PubMed  Google Scholar 

  12. Dickson JH, Mirkovic S, Noble PC, Nalty T, Erwin WD (1995) Results of operative treatment of idiopathic scoliosis in adults. J Bone Joint Surg Am 77(4):513–23 (published Online First: Epub Date)

    Article  CAS  PubMed  Google Scholar 

  13. Daubs MD, Lenke LG, Cheh G, Stobbs G, Bridwell KH (2007) Adult spinal deformity surgery: complications and outcomes in patients over age 60. Spine (Phila Pa 1976) 32(20):2238–44 (published Online First: Epub Date)

    Article  PubMed  Google Scholar 

  14. Cho KJ, Suk SI, Park SR et al (2007) Complications in posterior fusion and instrumentation for degenerative lumbar scoliosis. Spine (Phila Pa 1976) 32(20):2232–7 (published Online First: Epub Date)

    Article  PubMed  Google Scholar 

  15. Tribus CB (2003) Degenerative lumbar scoliosis: evaluation and management. J Am Acad Orthop Surg 11(3):174–83 (published Online First: Epub Date)

    Article  PubMed  Google Scholar 

  16. Carreon LY, Puno RM, Dimar JR 2nd, Glassman SD, Johnson JR (2003) Perioperative complications of posterior lumbar decompression and arthrodesis in older adults. J Bone Joint Surg Am 85(11):2089–92 (published Online First: Epub Date)

    Article  PubMed  Google Scholar 

  17. Smith JS, Shaffrey CI, Glassman SD et al (2011) Risk-benefit assessment of surgery for adult scoliosis: an analysis based on patient age. Spine (Phila Pa 1976) 36(10):817–24 (published Online First: Epub Date)

    Article  PubMed  Google Scholar 

  18. Elias E, Bess S, Line B et al (2022) Outcomes of operative treatment for adult spinal deformity: a prospective multicenter assessment with mean 4-year follow-up. J Neurosurg Spine. https://doi.org/10.3171/2022.3.SPINE2295. (published Online First: Epub Date)

    Article  PubMed  Google Scholar 

  19. Lenke LG, Fehlings MG, Shaffrey CI et al (2016) Neurologic Outcomes of Complex Adult Spinal Deformity Surgery: Results of the Prospective, Multicenter Scoli-RISK-1 Study. Spine (Phila Pa 1976) 41(3):204–12 (published Online First: Epub Date)

    Article  PubMed  Google Scholar 

  20. Hamilton DK, Smith JS, Sansur CA et al (2011) Rates of new neurological deficit associated with spine surgery based on 108,419 procedures: a report of the scoliosis research society morbidity and mortality committee. Spine (Phila Pa 1976) 36(15):1218–28 (published Online First: Epub Date)

    Article  PubMed  Google Scholar 

  21. Cook S, Asher M, Lai SM, Shobe J (2000) Reoperation after primary posterior instrumentation and fusion for idiopathic scoliosis. toward defining late operative site pain of unknown cause. Spine (Phila Pa 1976) 25(4):463–8 (published Online First: Epub Date)

    Article  CAS  PubMed  Google Scholar 

  22. Emami A, Deviren V, Berven S, Smith JA, Hu SS, Bradford DS (2002) Outcome and complications of long fusions to the sacrum in adult spine deformity: luque-galveston, combined iliac and sacral screws, and sacral fixation. Spine (Phila Pa 1976) 27(7):776–86 (published Online First: Epub Date)

    Article  PubMed  Google Scholar 

  23. Ahn UM, Ahn NU, Buchowski JM et al (2002) Functional outcome and radiographic correction after spinal osteotomy. Spine (Phila Pa 1976) 27(12):1303–11 (published Online First: Epub Date)

    Article  PubMed  Google Scholar 

  24. Edwards CC 2nd, Bridwell KH, Patel A, Rinella AS, Berra A, Lenke LG (2004) Long adult deformity fusions to L5 and the sacrum. a matched cohort analysis. Spine (Phila Pa 1976) 29(18):1996–2005 (published Online First: Epub Date)

    Article  PubMed  Google Scholar 

  25. McAfee PC, Weiland DJ, Carlow JJ (1991) Survivorship analysis of pedicle spinal instrumentation. Spine (Phila Pa 1976) 16(8 Suppl):S422-7

    CAS  PubMed  Google Scholar 

  26. Shapiro GS, Taira G, Boachie-Adjei O (2003) Results of surgical treatment of adult idiopathic scoliosis with low back pain and spinal stenosis: a study of long-term clinical radiographic outcomes. Spine (Phila Pa 1976) 28(4):358–63 (published Online First: Epub Date)

    Article  PubMed  Google Scholar 

  27. Khalid SI, Nunna RS, Maasarani S et al (2020) Association of osteopenia and osteoporosis with higher rates of pseudarthrosis and revision surgery in adult patients undergoing single-level lumbar fusion. Neurosurg Focus 49(2):E6 (published Online First: Epub Date)

    Article  PubMed  Google Scholar 

  28. Merrill RK, Kim JS, Leven DM, Kim JH, Cho SK (2017) Multi-Rod Constructs Can Prevent Rod Breakage and Pseudarthrosis at the Lumbosacral Junction in Adult Spinal Deformity. Global Spine J 7(6):514–20 (published Online First: Epub Date)

    Article  PubMed  PubMed Central  Google Scholar 

  29. Smith JS, Shaffrey E, Klineberg E et al (2014) Prospective multicenter assessment of risk factors for rod fracture following surgery for adult spinal deformity. J Neurosurg Spine 21(6):994–1003 (published Online First: Epub Date)

    Article  PubMed  Google Scholar 

  30. Paul JC, Lonner BS, Vira S, Kaye ID, Errico TJ (2016) Use of Recombinant Bone Morphogenetic Protein Is Associated With Reduced Risk of Reoperation After Spine Fusion for Adult Spinal Deformity. Spine (Phila Pa 1976) 41(1):E15-21 (published Online First: Epub Date)

    Article  PubMed  Google Scholar 

  31. Copay AG, Glassman SD, Subach BR, Berven S, Schuler TC, Carreon LY (2008) Minimum clinically important difference in lumbar spine surgery patients: a choice of methods using the Oswestry disability index, medical outcomes study questionnaire short form 36, and pain scales. Spine J 8(6):968–74 (published Online First: Epub Date)

    Article  PubMed  Google Scholar 

  32. Lenke LG, Zuckerman SL, Cerpa M et al (2021) The scoli-RISK 1 results of lower extremity motor function 5 years after complex adult spinal deformity surgery. Eur Spine J 30(11):3243–54 (published Online First: Epub Date)

    Article  PubMed  Google Scholar 

  33. Riley MS, Bridwell KH, Lenke LG, Dalton J, Kelly MP (2018) Health-related quality of life outcomes in complex adult spinal deformity surgery. J Neurosurg Spine 28(2):194–200 (published Online First: Epub Date)

    Article  PubMed  Google Scholar 

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Funding

The authors did not receive support from any organization for the submitted work.

Author information

Author notes

  1. Joseph M. Lombardi, Zeeshan M. Sardar, Ronald A. Lehman & Lawrence G. Lenke

    Present address: The Daniel and Jane Och Spine Hospital, New York Presbyterian, Columbia University Medical Center, 5141 Broadway, New York, NY, 10034, USA

Authors and Affiliations

  1. Department of Orthopaedic Surgery, The Och Spine Hospital, Columbia University Irving Medical Center, New York, NY, USA

    Stephen R. Stephan, Fthimnir M. Hassan, Christopher Mikhail, Andrew Platt, Erik Lewerenz, Joseph M. Lombardi, Zeeshan M. Sardar, Ronald A. Lehman & Lawrence G. Lenke

  2. Department of Orthopaedic Surgery, Scripps Clinic Medical Group, La Jolla, CA, USA

    Stephen R. Stephan

  3. Department of Orthopaedic Surgery, San Diego Spine Foundation, San Diego, CA, USA

    Stephen R. Stephan

  4. Department of Orthopaedic Surgery, Cedars-Sinai Spine Center, Los Angeles, CA, USA

    Christopher Mikhail

  5. Department of Neurosurgery, Loma Linda University Medical Center, Loma Linda, CA, USA

    Andrew Platt

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Contributions

SS, FMH, CM, AP, EL, JML, ZMS, RAL and LGL: contributed to the concept/design of the work, drafted the work, acquisition, analysis, and interpretation of the data, approved the version to be published, agrees to be accountable for all aspects of the work.

Corresponding author

Correspondence to Fthimnir M. Hassan.

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Conflict of interest

Fthimnir M. Hassan, Erik Lewerenz, Christopher Mikhail, Stephen Stephan, and Andrew Platt, have no relevant financial or non-financial interests to disclose. Lawrence G. Lenke has received grant support from AO Spine, International Spine Summit Group, Scoliosis Research Society, EOS Technology and Setting Scoliosis Straight Foundation as a study investigator. Ronald A. Lehman has received grant support from the Department of Defense as a study investigator. Joseph M. Lombardi, Zeeshan M. Sardar, Ronald A. Lehman, and Lawrence G. Lenke have received consulting fees from Medtronic. Joseph M. Lombardi has received consulting fees from Stryker. Lawrence G. Lenke has received consulting fees from Acuity Surgical and Abryx. Lawrence G. Lenke has received reimbursements from Broadwater, AO Spine, and Scoliosis Research Society for attending meetings/travel. Ronald A. Lehman and Lawrence G. Lenke have received royalties and are patent holders from Medtronic. Ronald A. Lehman has received royalties and is a patent holder from Stryker.

Ethical approval

AAAR6015 This retrospective chart review study involving human participants was in accordance with the ethical standards of the institutional and national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards. The Human Investigation Committee (IRB) of Columbia University Irving Medical Center approved this study.

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Informed consent was obtained from all individual participants included in the study.

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Stephan, S.R., Hassan, F.M., Mikhail, C. et al. Revision of Harrington rod constructs: a single-center’s experience with this homogenous adult spinal deformity population at a minimum 2-year follow-up. Spine Deform (2024). https://doi.org/10.1007/s43390-024-00867-2

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