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View Full Version : FAO Linda... older vs newer instrumentation



Pooka1
10-12-2009, 04:54 PM
I mentioned in some recent thread that I read a conclusion in a recent meeting abstract indicating that the older instrumentation was just as good as the newer in some cases. I finally found it and have highlighted the relevant sentences...

http://www.srs.org/professionals/meetings/am08/doc/oral_abstracts.pdf

Paper #82

A 13-14 Year Follow Up of Outcome for Fusions in Idiopathic Scoliosis
Colin Nnadi, FRCS(Orth) (Queens Medical Campus); Prakash Jayakumar, MRCS; Satoshi Hori, BSc, MB, BS, MRCS; Adrian Casey;
David Harrison, FRCS; Ben Taylor; Dimitri A. Raptis, MRCS

Introduction: Corrective Scoliosis surgery has evolved since the introduction of the Harrington instrumentation system. Newer
techniques of correction involve the use of segmental instrumentation which improves 3-dimensional correction. Previous
studies have based outcome assessments of surgery on the older instrumentation systems such as the Harrington system using
objective parameters such as radiographic data and health related quality of life measures. We now know that some of these
parameters are only weakly linked to outcomes more relevant to patients. Health related quality of life assessments have
addressed this issue considerably but still retain the drawback of not being specific to the condition being assessed. We have
used a validated and reliable disease specific questionnaire to evaluate outcome.

Methods: Over a 2 year period from 1993 to 1994, 101 patients with a diagnosis of Adolescent Idiopathic Scoliosis who had
undergone surgery in a tertiary institution in the UK were identified. These patients were recontacted and evaluated using
the Modified Scoliosis Research Society Questionnaire. Correlations between patient generated data and outcome were also
evaluated.

Results: There was an overall general satisfaction with surgery. No correlation was found between patient generated data and
outcome except in patients with posterior instrumentation extending proximal to T4 vertebra. In this group of patients the
outcome scores in 4 out of 5 domains of the questionnaire were significantly better than in other groups.

Conclusion: Using a disease specific questionnaire to evaluate surgically treated Idiopathic Scoliosis we have identified the
proximal extent of the fusion as the single variable to affect outcome. This contrasts with previous work which has focused on
the distal extent of fusion. We have also shown that the Harrington system, contrary to opinion, compares favourably with the
more modern instrumentation systems.

Significance: The strength of our study is the focus on patient based evaluation of the effects of scoliosis surgery. Suprisingly,
there are no significant differences in outcome between older and more modern corrective techniques despite the perceived
theoretical advantages of the latter.

-------------

Now I am guessing this pertains only to T fusions given the known incidence of flatback syndrome with L fusions w/ Harrington rods (yes?) but they didn't mention that.

LindaRacine
10-12-2009, 10:03 PM
Well, that explains why I didn't hear it (it was last year).

The paper brings up far more questions than answers. For example, is it possible that the surgeons at this institution aren't (or weren't) very adept at implanting the newer hardware?

I've read it a dozen times now, and I still can't make sense of this:


No correlation was found between patient generated data and
outcome except in patients with posterior instrumentation extending proximal to T4 vertebra. In this group of patients the
outcome scores in 4 out of 5 domains of the questionnaire were significantly better than in other groups.

Jimbo
10-12-2009, 11:57 PM
Very interesting.

I am surprised by these findings.