Harrington Instrumentation Without Fusion Plus External Orthotic Support for the Treatment of Difficult Curvature Problems in Young Children

Moe, John H.; Kharrat, Khalil; Winter, Robert B.; Cummine, John

doi:10.1097/00003086-198405000-00006

Cited by 176 publications

(98 citation statements)

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“…Blakemore et al [1] and Morin [15] introduced segmental spinal instrumentation systems (Cotrel-Dubousset, Isola, etc) for severe spinal deformities in young children. However, in all of these procedures, spontaneous bony fusion can occur before the patients reach maturity [7,14], also causing posterior ankylosis and crankshaft [5].Abstract "Spinal instrumentation without fusion" techniques, which do not interfere with spinal growth, have been used extensively in the treatment of progressive spinal scoliosis in very young children. Due to subperiosteal exposure, the process of spinal instrumentation may induce spontaneous bony fusion.…”

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confidence: 99%

Inhibition of spinal fusion by use of a tissue ingrowth inhibitor

Zou

Egund

et al. 2004

European Spine Journal

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IntroductionBecause of the associated disturbance of spinal growth, surgery for progressive spinal deformities in very young children is a challenging task. Most foregoing studies report having used a "growing spinal instrumentation without fusion" technique in order to avoid interference with spinal growth. Harrington first described the procedure, which used a Harrington rod [10]. The "Luque trolley" technique of segmental spinal instrumentation without fusion has been used with some success [13,14,18]. Blakemore et al [1] and Morin [15] introduced segmental spinal instrumentation systems (Cotrel-Dubousset, Isola, etc) for severe spinal deformities in young children. However, in all of these procedures, spontaneous bony fusion can occur before the patients reach maturity [7,14], also causing posterior ankylosis and crankshaft [5].Abstract "Spinal instrumentation without fusion" techniques, which do not interfere with spinal growth, have been used extensively in the treatment of progressive spinal scoliosis in very young children. Due to subperiosteal exposure, the process of spinal instrumentation may induce spontaneous bony fusion. Instrumentation and surgical techniques have been modified in order to prevent spontaneous posterior fusion from occurring in children. An absorbable ADCON-L gel has been shown to inhibit scar and epidural adhesions following spinal surgeries. However, little is known about its influence on spinal fusion. In the present study, a single-level intertransverse arthrodesis at L4-5 on both sides was performed on each of nine pigs. Each side was randomly designed to receive autogenous bone graft with or without ADCON-L gel. The animals were followed for 10 weeks postoperatively. A fusion rate of 78% (7/9) was obtained in the autograft treatment by plain X-ray and CT evaluation, while the autograft/ADCON-L treatment yielded a 0% (0/9) fusion rate (p=0.001). Histomorphometric evaluation revealed that the addition of ADCON-L gel to bone graft decreased bone and bone marrow formation and significantly increased fibrous tissue formation. No statistical difference between the two treatments was found in cartilage, bone surface density, osteoid surfaces or osteoclast-covered surfaces in any zone. We conclude that ADCON-L gel mixed into autogenous bone graft can delay or decrease bone formation at spinal arthrodesis sites, thus influencing the extent of spinal fusion. This accords with our hypothesis that the use of ADCON-L gel can prevent not only the occurrence of spontaneous fusion in very young scoliosis patients after instrumentation without fusion, but also re-ossification of a decompressed spinal canal.

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confidence: 99%

Inhibition of spinal fusion by use of a tissue ingrowth inhibitor

Zou

Egund

et al. 2004

European Spine Journal

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“…When radiological measurement documents progression, and particularly if the curve reaches a magnitude greater than 40°, surgical treatment should be considered. Posterior distraction spinal instrumentation is the recommended treatment for these patients [5,6,8,10,12,14,18,19,21,22].…”

Section: Discussionmentioning

confidence: 99%

“…Definitive arthrodesis can be delayed until the end of the adolescent growth spurt [5,6,8,10,11,12,14,19].…”

Section: Discussionmentioning

confidence: 99%

“…He reported that subperiosteal exposition of the spine could lead to spontaneous fusion over the length of the instrumentation [5]. In order to minimize the chances of this complication occurring Moe et al [12] recommended a subfascial positioning of the Harrington rods [8,12,19]. With this technique the only portion of the spine exposed were the sites of the hook insertion, whilst the rest of the spine, undisturbed, would be less likely to fuse [5,8].…”

Section: Discussionmentioning

confidence: 99%

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Infantile scoliosis in Beals syndrome: the use of a non-fusion technique for surgical correction

et al. 2005

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Beals syndrome (congenital contractural arachnodactyl) is a genetic disorder of the connective tissue phenotypically related to Marfan syndrome. It is characterised by dolichostenomelia, arachnodactyly, multiple joint contractures, crumpled ears, hypoplastic muscles and scoliosis. The latter, the most important clinical feature of this rare condition, presents in the infantile and juvenile age group and has a tendency to rapid progression. Bracing often fails to control the scoliosis and surgery is the recommended treatment. We present our experience of two cases managed with the paediatric Isola instrumentation and a non-fusion technique.

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“…Reports of Harrington rods used without fusion go back as early as the late 1970s and early 1980s [5]. Moe et al [6] described a technique similar to that used today, where the subcutaneous insertion of a Harrington rod was intended to function like an internal brace, and it was supplemented with the use of external orthosis postoperatively. No segments were fused and the rod distracted periodically according to the indication of an increase in deformity by 10°.…”

Section: Conception and Historymentioning

confidence: 99%

Growing rod concepts: state of the art

Yazıcı

Olgun

2012

Eur Spine J

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Introduction Early-onset spinal deformities present multiple challenges to the surgeon. They may be rapidly progressive and unresponsive to conservative treatment, necessitating surgical intervention at an early age. Materials and methods This text attempts to provide a review of current literature and to summarize the authors' opinions. Results This paper attempts to concisely review available literature regarding the growing rod's inception, evolution, technique, results, and complications and answers some of the controversy still surrounding it. Conclusions The growing rod is one of the first, most evolved, most popular and one of the most heatedly discussed technique of fusionless spinal instrumentation.

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Harrington Instrumentation Without Fusion Plus External Orthotic Support for the Treatment of Difficult Curvature Problems in Young Children

Cited by 176 publications

References 0 publications

Inhibition of spinal fusion by use of a tissue ingrowth inhibitor

Inhibition of spinal fusion by use of a tissue ingrowth inhibitor

Infantile scoliosis in Beals syndrome: the use of a non-fusion technique for surgical correction

Growing rod concepts: state of the art

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