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Radicular pain after Harrington instrumentation
1New York University Medical Center, New York.
Journal of Spinal Disorders
|March 1, 1989
Summary
Harrington instrumentation for scoliosis can cause nerve pain due to hook compression. Removing the hardware relieved pain, and new bracing techniques may prevent this complication.
Area of Science:
- Orthopedic Surgery
- Spinal Fusion
- Pediatric Orthopedics
Background:
- Harrington instrumentation is a common surgical technique for idiopathic scoliosis.
- Posterior spinal fusion aims to correct spinal deformities and prevent progression.
- Lumbar radicular pain can be a debilitating complication following spinal surgery.
Observation:
- Three patients experienced persistent radicular and buttock pain post-Harrington instrumentation and spinal fusion.
- Clinical evaluation revealed nerve root compression directly caused by the inferior hook.
- Intraoperative findings showed the inferior hook encased in bone, imploded into the spinal canal due to lamina stress fracture.
Findings:
- Surgical removal of the entire Harrington instrumentation effectively relieved nerve root compression.
- Complete resolution of radicular pain was achieved after hardware removal.
- The complication appears linked to the inferior hook's position and potential for mechanical failure.
Implications:
- This case series highlights a potential complication of Harrington instrumentation in scoliosis surgery.
- Modification of postoperative bracing with leg extensions for L4/L5 instrumentation may mitigate this risk.
- Further research into implant design and surgical technique is warranted to minimize neurological complications.