Back Pain and Disability After Harrington Rod Fusion to the Lumbar Spine for Scoliosis

Radiographic Predictors of Outcome After Long Fusion to L5 in Adult Scoliosis

“…6,11 Despite the fact that all patients in this study were fused using third-generation segmental fixation, posterior instrumentation alone without anterior release and fusion was unable to fully restore normal lumbar lordosis. At an average 32 months' follow-up, three patients (19%) demonstrated progressive postoperative loss of lumbar lordosis, and one of those patients demonstrated radiographic evidence of degeneration at L5-S1.…”

“…4,5 Current protocol dictates that fusion in adolescent scoliosis should not extend past L4, 5 and it has been demonstrated that patients older than 30 years have a greater risk of pain and decreased function if fused below L3 for idiopathic adolescent scoliosis. 11 However, most cases of symptomatic adult scoliosis affect the lumbar spine primarily, 12 and structural changes in adults often dictate that the fusion extend to L5 or S1. Horton et al 13 recently postulated that fusion excluding L5-S1 would ultimately place an unacceptable load on the "saved" disc space.…”

Idiopathic scoliosis instrumentation using the Lea Plaza sublaminar frame

“…Other indications for anterior fusion in skeletally mature patients are curves greater than 60°, when there is less than 50% correction on lateral bending, an ugly hump and an unbalanced trunk. Anterior fusion provides better stability and avoids fusion below L3 ( Figures 1 to 5); older patients are more likely to develop degenerative disc changes below this level [9,13].…”

“…Harrington distraction rods were the first effective instrumentation developed for the treatment of idiopathic scoliosis, but had the disadvantage of producing flattening of the sagittal contour of the lumbar spine [13,16]. Long term studies of these patients have revealed a high incidence of low back pain and a loss of sagittal balance, known as the flat back syndrome.…”

“…Long term studies of these patients have revealed a high incidence of low back pain and a loss of sagittal balance, known as the flat back syndrome. There is controversy about the correlation of low back pain and the extent of fusion below the 3rd lumbar vertebra with the loss of normal lordosis [4,13].…”