Our Summary

This research paper reviews the long-term outcomes of a type of surgery used to treat a condition called adolescent idiopathic scoliosis (AIS), a curvature of the spine that typically develops in teenagers. The technique, called Harrington instrumentation (HRI), was a major step forward in treating this condition when it was introduced in the 1960s, but there have been ongoing concerns about its impact on the spine’s shape and its connection to lower back pain.

The researchers looked at the results of 11 studies involving 644 patients who had undergone HRI and been followed up for at least 10 years. They found that the surgery did successfully reduce the curve of the spine, although some of this correction was lost over time. The procedure also changed the shape of the spine in the chest and lower back areas. In some cases, further surgeries were needed, and the patients reported higher levels of lower back pain than people without scoliosis. However, overall, the patients’ quality of life and ability to function were similar to those of people without the condition.

In conclusion, despite some drawbacks, the long-term results of HRI are generally positive. The surgery does change the shape of the spine and can lead to lower back pain, but it does not necessarily result in disability or significantly impact patients’ quality of life.

FAQs

  1. What is Harrington instrumentation (HRI) and how does it treat adolescent idiopathic scoliosis (AIS)?
  2. What are the long-term outcomes for patients who undergo HRI surgery?
  3. Does HRI surgery lead to lower back pain and does it significantly impact the quality of life of patients?

Doctor’s Tip

One helpful tip a doctor might tell a patient about scoliosis surgery is to follow a comprehensive post-operative rehabilitation program. This may include physical therapy, exercises to strengthen the muscles supporting the spine, and proper body mechanics to prevent strain on the back. By actively participating in rehabilitation, patients can improve their recovery process, reduce the risk of complications, and optimize their long-term outcomes after scoliosis surgery.

Suitable For

Typically, patients with severe cases of adolescent idiopathic scoliosis who have not responded well to other treatments, such as bracing or physical therapy, are recommended for scoliosis surgery. These patients typically have a spinal curvature greater than 40-50 degrees, which can lead to physical deformity, pain, and potential complications with lung and heart function. Surgery is usually considered as a last resort to correct the curvature of the spine and prevent further progression of the condition.

Timeline

Before scoliosis surgery:

  1. Diagnosis of scoliosis through physical examination and imaging tests.
  2. Monitoring of the progression of the spinal curvature over time.
  3. Evaluation of the patient’s overall health and fitness for surgery.
  4. Discussion of treatment options with the patient and their family.

After scoliosis surgery:

  1. Recovery period in the hospital, typically lasting a few days to a week.
  2. Physical therapy and rehabilitation to help the patient regain strength and mobility.
  3. Monitoring of the surgical site for any signs of infection or complications.
  4. Follow-up appointments with the surgeon to assess the success of the surgery and monitor the spine’s alignment.
  5. Long-term follow-up to track any changes in the spine, potential need for further surgeries, and management of any ongoing lower back pain.

What to Ask Your Doctor

  1. What are the potential risks and complications associated with scoliosis surgery, specifically Harrington instrumentation?
  2. What is the success rate of the surgery in terms of reducing the curvature of the spine?
  3. How long is the recovery period after scoliosis surgery, and what is involved in the post-operative care?
  4. Are there any long-term effects of scoliosis surgery, such as changes in spine shape or increased risk of lower back pain?
  5. Will I need any additional surgeries or treatments in the future after undergoing scoliosis surgery?
  6. How will scoliosis surgery impact my daily activities, such as exercise or sports participation?
  7. Are there any alternative treatments or therapies that could be considered instead of surgery for scoliosis?
  8. What is the expected outcome in terms of pain relief and improvement in quality of life after scoliosis surgery?
  9. How experienced is the surgical team in performing scoliosis surgeries, and what is their success rate?
  10. Are there any specific lifestyle changes or precautions I should take after undergoing scoliosis surgery to maintain the results and prevent complications?

Reference

Authors: Barile F, Ruffilli A, Morandi Guaitoli M, Viroli G, Ialuna M, Manzetti M, Cerasoli T, Artioli E, Traversari M, Mazzotti A, Faldini C. Journal: Musculoskelet Surg. 2025 Mar;109(1):17-31. doi: 10.1007/s12306-024-00836-y. Epub 2024 May 28. PMID: 38806854