Long-term results after Harrington instrumentation: increased translation and pain

Sixty-eight patients with idiopathic scoliosis who had undergone Harrington instrumentation at least 10 years previously (mean follow-up 14 years) were asked to return to our hospital for review. History and clinical examination were performed in 49 individuals (72%), radiographs in 44 individuals (64%). Pain was evaluated by means of the Dallas Pain Questionnaire and pain drawings according to Ransford. Segmental range of motion according to Begg and Falconer as well as sagittal translational motion measured according to Wiltse and Winter and to Morgan and King were evaluated in flexion/extension radiographs. Pain depended on fusion level. It occurred in 80% of those in whom fusion was carried down to L4 or lower vertebrae. There was no relationship between fusion level or pain on the one hand and segmental range of motion or increased translation on the other hand, and none between lordosis, pain and increased translation. Increased sagittal translocational motion of more than the measurement error of 5 mm does not seem to be an important cause of pain in individuals in whom Harrington instrumentation was carried down to low vertebral levels.