Jesse H. Dickson

Results of reduction and stabilization of the severely fractured thoracic and lumbar spine.

From 1962 to 1976, ninety-five patients with fracture-dislocations of the spine were treated with Harrington instrumentation and fusion within ninety days of injury. This report presents the results of this procedure related to reduction, stabilization, return of neural function, and total hospital stay. Mean follow-up was twenty-one months. Reduction and stabilization were attained without a substantial number of complications, but no more return of neural function in the patients was evident than has been reported in the literature for patients treated with postural reduction and bed rest. Total hospital stay averaged 107 days from day of injury.

Results of operative treatment of idiopathic scoliosis in adults.

We compared the results in eighty-one patients (average age, fifty-six years; range, forty-three to eighty-three years) who had had operative treatment of idiopathic scoliosis with those in thirty patients (average age, fifty-eight years; range, forty-five to seventy years) who had declined operative treatment. Seventy-six individuals (average age, forty-eight years; range, thirty-five to seventy-four years) who did not have scoliosis served as a control group. The average duration of follow-up was five years (range, two to seventeen years). The population base consisted of 454 patients who were seen between 1970 and 1985. The treated patients were drawn from a group of 160 patients for whom an operation had been recommended; 110 patients agreed to the operation and fifty refused. The remaining 294 patients had curves of insufficient severity to warrant concern about progression, had symptoms unrelated to the scoliosis, or had curves that did not necessitate any intervention. The functional status since the operation (for the treated patients), since recommendation of the operation (for the untreated patients), or within the last ten years (for the control group) was evaluated with a comprehensive questionnaire designed to elicit details regarding pain, fatigue, and any disability in the performance of twenty-six activities of daily living. At the most recent follow-up examination, the treated patients reported a significantly greater decrease in pain and fatigue and significantly more improvement in self-image and in the ability to perform physical, functional, and positional tasks than did the untreated patients (p = 0.0001).

Harrington instrumentation and arthrodesis for idiopathic scoliosis. A twenty-one-year follow-up.

A questionnaire was sent to 206 consecutive patients who were operated on for idiopathic scoliosis by Dr. Paul R. Harrington between 1961 and 1963. Eighty-three per cent of the patients responded to the questionnaire, which consisted of five sections: demographic data, activities of daily living, back symptoms (pain and fatigue), a history of personal and family health, and a personal assessment of the back. One hundred and eleven patients also sent recent radiographs. A control group, comprising 100 individuals who did not have scoliosis and had been matched for age and sex, was given the same questionnaire. The study group had more pain in the interscapular and thoracolumbar regions compared with the control group, but there was no difference with respect to pain in the lumbosacral area or the low back. Neither pain nor fatigue was related to the type of curve, the preoperative degree of curvature, the degree of curvature as seen on the most recent radiograph, the extent of fusion into the lumbar spine, or the presence of a broken rod. Twenty-one years after the operation, the patients were functioning quite well compared with the control subjects.

Spinal Instrumentation in the Treatment of Severe Progressive Spondylolisthesis

By using A-frame instrumentation and direct distraction force, an exceptional correction can be obtained in patients with severe spondylolisthesis. Adolescent progressive spondylolisthesis should be considered as an entity separate from the lumbosacral anomalies such as spondylolysis and grades 0 and 1 spondylolisthesis without progression. An aplastic relationship appears to exist between the sacrum and the posterior superior wing of the ilium in the adolescent with progressive spondylolisthesis. Complications have been minimal but long-term observations of patients are necessary to evaluate the contribution of instrumentation in the treatment for severe progressive spondylolisthesis.

Efficacy and cost considerations of intraoperative autologous transfusion in spinal fusion for idiopathic scoliosis with predeposited blood.

Study Design One hundred five patients with adolescent idiopathic scoliosis who underwent posterior spinal instrumentation and fusion with predeposited autologous blood, with or without intraoperative autologous transfusion, were reviewed. Objective To determine the benefit/nonbenefit of intraoperative autologous transfusion in diminishing the need for homologous blood and influencing postoperative hematocrit values in healthy adolescents undergoing spinal fusion for scoliosis. Summary of Background Data A steady increase in the use of intraoperative autologous transfusion in recent years has occurred without guidelines regarding which procedures and patient populations would be best served. Previous studies have failed to determine the cost effectiveness and actual reduction in homologous blood exposure attributable to intraoperative autologous transfusion in adolescents who have undergone preoperative phlebotomy. Methods Fifty‐five adolescents (intraoperative autologous transfusion group) who underwent posterior instrumentation and fusion for idiopathic scoliosis with the use of an intraoperative autologous transfusion device were compared to 50 patients (control group) who underwent the same procedure without the intraoperative autologous transfusion device. Results The average percent salvage of red blood cells by the intraoperative autologous transfusion device was 35%. The control group utilized significantly more of the predonated autologous blood than the intraoperative autologous transfusion group (1.34 units/case vs. 1.78 units/case, P<0.05). Homologous blood usage was the same in both groups. Two patients in the intraoperative autologous transfusion group required nondirected homologous blood (total of four units), compared to three patients in the control group (total of four units) (P=0.048). Using multiple regression analysis, the total number of transfusions was significantly correlated with the estimated blood loss and the duration of surgery in both groups. Postoperative hematocrit levels were slightly higher in the control group, but there was not a significant difference. Conclusions The addition of intraoperative autologous transfusion to a preoperative phlebotomy program had no benefit on homologous blood exposure or postoperative hematocrit changes in this population. Blood requirements for this procedure can be met less expensively and more reliably by merely donating ones own blood.

Results of Harrington instrumentation and fusion in the adult idiopathic scoliosis patient

Between January 1961 and December 1972, 132 patients over twenty years old with idiopathic scoliosis were surgically treated using Harrington instrumentation and fusion techniques. All patients were seen by us because of curve magnitude or symptoms secondary to scoliosis. The average correction obtained at operation was 48 per cent. Twenty-four patients had early complications. Fifty-two had late complications, the most frequent of which was pseudarthrosis. The majority of patients had significant improvement in symptoms as a result of surgical correction and stabilization.

Effect of operative position on sagittal alignment of the lumbar spine

A variety of techniques and frames are used for positioning patients during posterior lumbar spinal instrumentation and fusion. Little information is available on the relationship of lumbar lordosis and the various positioning options, so it was felt that further investigation was warranted. Ten volunteers with no history of back pain were positioned and radiographed in the standing position followed by four lateral radiographs with the patient positioned on chest rolls, Andrews frame, the Hastings frame, and a four-poster spinal frame. Total lumbar lordosis from L1 to S1 as well as intervertebral body angles at each of the lumbar interspaces using standardized techniques were computed. No significant difference was found in lumbar lordosis between the standing and chest roll position. However, there was approximately a 50% reduction in lumbar lordosis when using the Hastings, Andrews, and four-poster frame as compared to the standing and chest roll configuration. The clinical implications are discussed.

The Evolution of the Harrington Instrumentation Technique in Scoliosis

Four major modifications in the operative management of scoliosis, using Harrington instrumentation, are described with the results each modification brought about. The final regimen, used in 109 patients, included a dowel articular-process fusion and a lateral gutter fusion, as well as the Harrington apparatus and cast. A 65 per cent curve correction was obtained with the regimen.

An in-vitro biomechanical comparison of the Orosco and AO locking plates for anterior cervical spine fixation

The Orosco anterior cervical spine plate (H-plate) and the Morscher AO cervical locking plate (CSLP) were studied to determine their comparative in vitro mechanical properties in flexion. Human cadaver cervical spines were tested nondestructively in flexion as intact, destabilized, and stabilized specimens with both implants. Stabilized specimens were also subjected to a large angular displacement in an attempt to induce implant failure. Differences between intact, destabilized, and stabilized specimens were significant for both the CSLP and H-plate groups in flexion testing (p < 0.05). Large angular displacement testing resulted in plate/screw displacement with the H-plate but not with the CSLP. Small angular displacements in flexion was tolerated well by both implants, but only the CSLP maintained stability with large angular displacements.

Clinical review of patients with broken Harrington rods.

The medical records and roentgenograms of 2,016 patients who were operated on from 1961 through 1974 using Harrington spinal instrumentation were reviewed to determine the incidence, clinical significance, and management of broken distraction and compression rods. The cases were divided into two study groups. Group A includes 1,128 patients operated on from 1961 through 1968, when no autogenous iliac-bone graft material was used, and Group B includes 888 patients operated on from 1969 through 1974, when autogenous bone was used. The incidence of broken distraction rods was 12.5 per cent (141 patients) in Group A and 2.1 per cent (nineteen patients) in Group B. The age of the patient at operation was not found to be a significant factor when comparing patients with fractured rods and those with intact rods; however, preoperative curve magnitude was found to influence the incidence of rod fractures. Reinstrumentation of distraction rods was required in twenty-three patients from Group A, but no patients in Group B required reinstrumentation. Eleven patients from Group A required removal of the rods. The compression rod fractured in forty patients (3.5 per cent) in Group A and in one patient in Group B; none required reinstrumentation or rod removal. The clinical management of rod fractures must be individualized for each patient. Reinstrumentation and fusion may be indicated in patients with early rod fracture, total loss of correction, or overlapping of the rod, but not in patients experiencing little or no loss of correction and no associated symptoms.