View Full Version : A 29 years and going strong H-rod success story

04-15-2012, 12:09 PM
The importance of being able to stay above L3. If that can be done, even H-rods can be a good solution. This is why I think they have largely "solved" T fusions for several decades now. The pedicle screws are just icing on that cake. T fusions, with so little need to preserve the minimal motion there, were low hanging fruit. Now they need to solve L fusions.


Her fusion looks awesome, hardware is intact, and her 3 discs below the Harrington Rod fusion all are well preserved without flat back syndrome, or spondylolisthesis (slippage).

04-15-2012, 12:31 PM
Maximizing preserved motion segments, while still maximizing curve correction is key to long-term success. In fact, today in clinic I saw a very pleasant 42 yo woman who had scoliosis surgery back in 1972 by Dr. Coonrad, who was here at Hey Clinic to have her young teenage daughter screened for scoliosis. Dr. Coonrad saved 3 of the lower discs below her double curve, and now 36 years later her discs below look just great, and she has no significant back pain. Historically, patients who had long Harrington Rod fusions with only one or two discs remaining preserved did not do as well as those who had 3 or more (3 doing better than 2, doing much better than just 1 disc remaining). Having more shock absorbers is better than fewer.



It seems like the long-term on surgical cases that stay above L3 needs to be compared to the long-term on ALL unfused curves. I'd love to see that study. I think it might reveal less total damage because of the more balanced spine in the fusion cases. The common quote about not needing surgery for smaller curve might be true for progression. But how many scoliosis patients escape fusion for damage and ancillary pain over a lifetime from simply have a curve for decades? That's an open question as far as I can tell. The surgery threshold should be lower for T curves than for L curves. And may be it should be lowest for TL curves... some surgeons realize this and do fuse at lower angles to save lumbar levels. We have two cases on the group of that.

I think it might be the mother of all misleading statements to focus parents on progression only and staying below a certain angle at maturity if most of these patients with smaller curves acquire constant damage from simply having the curve and require intervention for that. We have no idea if that is or is not the case. We need a study, especially to investigate the average length of fusion versus age. I bet it has a positive slope though would be very noisy. Parents should know that if true.

04-15-2012, 04:27 PM