Background:

Harrington instrumentation for adolescent idiopathic scoliosis (AIS) was revolutionary and allowed patients to mobilize faster as compared with patients treated with uninstrumented fusion. However, Harrington instrumentation provided correction of the deformity in 1 plane, resulting in limited sagittal plane control. Patients who received these 2 surgeries are aging, and to date, ultralong follow-up of these patients has not been reported.

Objective:

The purpose of this study was to evaluate long-term patient-reported outcomes and radiographic parameters after Harrington nonsegmental distraction instrumentation vs uninstrumented fusion in the treatment of AIS.

Methods:

Fourteen adult patients with AIS who were previously instrumented (n = 7) or uninstrumented (n = 7) were identified. Recent x-ray image measurements such as pelvic incidence (PI), sagittal vertical axis (SVA), pelvic tilt (PT), lumbar lordosis (LL), and pelvic incidence minus lumbar lordosis (PI-LL) were used to analyze deformities. Scoliosis Research Society-7 (SRS-7), Neck Disability Index (NDI), and Oswestry Disability Index (ODI) were used to evaluate patient-reported outcomes. Complications and rates of revision surgery were also evaluated.

Results:

The mean age was 67.1 ± 5 years in the instrumented group and 64.1 ± 9 years in the uninstrumented group. There were no significant differences between instrumented and uninstrumented in SRS-7 (23.4 ± 2.9 vs 23.6 ± 2.6, P = 0.93), NDI (5.7 ± 4.5 vs 10.6 ± 4.5, P = 0.08), and ODI (9.7 ± 13.7 vs 9.4 ± 8.7, P = 0.99). Radiographic measurements of instrumented vs uninstrumented resulted in comparable PT (24.0 ± 7.9 vs 30.5 ± 4.7, P = 0.09), PI (61.3 ± 16.9 vs 67.2 ± 9.5, P = 0.47), LL (34.9 ± 14.4 vs 42.8 ± 11.0, P = 0.29), PI-LL (26.4 ± 25.1 vs 24.3 ± 10.4, P = 0.43), and SVA (38.1 ± 30.1 vs 52.3 ± 21.6, P = 0.37). There were 2 patients in the instrumented group who developed adjacent segment disease that required operative intervention compared with none in the uninstrumented group (P = 0.46).

Conclusion:

In long-term follow-up of instrumented and uninstrumented fusion, patients had similar patient-reported outcomes and radiographic parameters, although the instrumented cohort had higher rates of adjacent segment disease.