Comparison of Long-Term Functional and Radiological Outcome After Harrington or Cotrel-Dubousset Instrumentation in Adolescent Idiopathic Scoliosis: A Retrospective Comparison of Two Cohorts

• (a - Instrumentation Scientific Foundation; Emil Aaltonen Foundation; Päivikki and Sakari Sohlberg Foundation)

Background: Cotrel-Dubousset instrumentation (CDI) has been reported to give better radiological correction than Harrington instrumentation (HI) in adolescent idiopathic scoliosis (AIS). However, it is unclear whether better long-term clinical or functional outcome could be obtained using posterior intersegmental instrumentation (Cotrel- Dubousset) than HI. No comparative studies have been conducted on the long-term radiological and functional outcome, including spinal mobility and trunk strength, of HI and CDI in AIS.Methods - Seventy-eight (mean age thirty-six years) of ninety-eight patients surgically treated with HI and fifty-seven (mean age twenty-eight years) of seventy-one treated with CDI for AIS participated in the present study. The average follow-up time was 20.8 years (range, 19.1 to 22.4 years) for the HI and 13.0 years (range, 11.2 to 15.0 years) for the CDI group. Radiographs were obtained preoperatively, at 2-year follow-up, and at final follow-up. Additionally, a physical examination was performed, and the Scoliosis Research Society (SRS) questionnaire was completed; spinal mobility and nondynamometric trunk strength were measured at the final follow-up visit.Results - The mean Cobb angle of the instrumented thoracic curve was preoperatively 53º (range, 37º to 79º) for the HI and 55º (range, 36º to 83º) for the CDI group. The mean number of instrumented vertebrae was 10.7 (range, 8 to 14) in the HI and 9.9 (range, 7 to 12) in the CDI group. At 2-year follow-up, the corresponding Cobb angles were 38º (range 18º to 70º) for the HI and 25º (range, 8º to 58º) for the CDI group (p <0 .001). At final follow-up, the mean angles were 45º (range, 19º to 76º) for HI and 32º 13º 63º) CDI group (p="" < 0.001). No significant difference was observed in thoracic kyphosis or lumbar lordosis between study groups at follow-up. Both scored a total of 97 points SRS questionnaire. In questionnaire, ten (13%) patients six (11%) reported having low back pain often very rest. correlation found Cobb angle curves follow-up score indexes this Non-dynamometric trunk strength measurements corresponded with age- sex-adjusted reference values, on average, but performed significantly better squatting test. Abnormal extension side bending more common than group. Complications recorded nine (12%) fifteen (26%) 0.027).Conclusions - yielded correction AIS coronal plane did HI. The subjective outcome according questionnaire not differ groups. Spinal mobility group, measurements.

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