Paul R. Harrington

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.

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.

The etiology of idiopathic scoliosis.

A multiple-factor approach to the puzzling diagnosis of idiopathic scoliosis is presented in an effort to shed some light on the ever-pervasive shadows of the unknown. Each factor, i.e., nutrition, hormonal influence, genetic tendency, and spinal mechanics, is discussed in detail and with excerpts and summaries from substantive recent literature are presented. Research in molecular chemistry, enzymes, coenzymes, genes, proteins, hormones, etc., at last is beginning to reveal secrets to those who have persevered in the laboratory. It would appear that a relatively minor deficiency in the disk collagen can cause the idiopathic scoliotic development in the spine. A nutritional deficit during the vulnerable growing years (hormonal influence) may initiate the scoliotic process, with the genetic tendency being a recessive factor. Thereafter, given the initial deficit, the spine has no choice--it must react to force, time and direction (mechanics of the spine)--and ultimately produce scoliosis.

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.

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.

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.

Is Scoliosis Reversible?: In Vivo Observations of Reversible Morphological Changes in the Production of Scoliosis in Mice

Without altering the osseous or muscular structure of Balb/c mice, the author was able to produce and reverse scoliotic deformation during the period of growth and development. Two series of investigations were performed, each involving extensive histological, morphological, and roentgenographic documentation: (1) control mice were maintained and sacrificed for examination at designated intervals and (2) experimental mice, whose right hind- and forequarters were surgically bound to allow only unilateral motion, were sacrificed and examined at corresponding intervals. The unilateral restriction of experimental animals were released at scheduled 5-day intervals during the 45-day period. These mice were then examined for restoration of normal histological and roentgenographic appearance. Changes in vertebral morphology were apparent after 35 days of restriction. Release at this time allowed restoration of normal vetebral appearance with the exception of a slight, measurable reduction in size. The results indicate that (1) limited activity retarded growth and (2) unilateral restriction caused geometrical variations (structural and morphological). Both of these alterations proved reversible once normal function (reciprocal motion) was restored to the murine spine.

Results of Harrington Instrumentation in the Treatment for Severe Scoliosis

Between July 1963 and December 1974, we surgically treated 207 patients who had severe scoliosis (curves greater than 90 degrees), 196 of whom were eligible for inclusion in this study. No patient was treated preoperatively with a cast or traction. Upon statistical analysis, age and preoperative curve magnitude proved to be significant variables relative to the amount of surgical correction obtained and the maintenance of that correction; sex and etiology of the scoliosis were not shown to affect either surgical outcome or maintenance of correction. A comparative analysis showed our results to be as good as those reported by others using various preoperative regimens of casting or traction or both. Therefore, we find that the preoperative application of traction to patients with severe scoliosis yields no better correction than the use of Harrington instrumentation and fusion alone.

The postoperative management of scoliosis patients treated with Harrington instrumentation and fusion

A retrospective study of maintenance of correction as affected by modifications in the management of patients surgically treated for scoliosis showed better results in Group B than in Group A. No supplementary bone was used in the 187 patients in Group A, who were maintained recumbent for three months postoperatively and who wore an underarm body cast for six months. The 177 patients in Group B received autogenous iliac-bone grafts, were allowed to walk seven to ten days postoperatively, and wore an underarm body cast for nine months. By two years postoperatively the patients in Group A had lost an average of 8.3 degrees of correction, and the patients in Group B had lost 4.3 degrees. A pseudarthrosis developed in eight patients in Group A and in one patient in Group B.

Instrumentation of the Spine for Fracture Dislocations in Children

13 children, ages 11-16 years, sustained severe compression fractures or fracture dislocations of the thoracolumbar spine. All cases were treated with Harrington instrumentation with fusion and six also had decompressive laminectomy. All injuries had significant instability and neurologic deficits (nine complete). Follow-up of 2-10 years is provided for analysis of maintenance of reduction and neurologic improvement. This technique appears to offer stability, reduction of orthopedic defects, and assumption of a more aggressive rehabilitation program without introducing significant operative morbidity or neurologic deficit.