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Scoliosis

Spinal Instrumentation

Paul Harrington

The treatment of the condition goes right back in history from the early 19th and 20th Centuries, from the development of the plaster jacket, right thought to spinal instumentation used in surgery.







Harrington Rod

Harrington Rod 1950

Owing to the efforts of Paul Harrington and others there had being advances made into the stabilising of the spine, with the first instrumentation to be developed.

The Harrington rod was developed in the 1950s by Paul Harrington. It was a major advance in the treatment of scoliosis.

For the first time, surgeons were able to use the distraction forces provided by the rod to hold the spine in a corrected position while the underlying spine fusion took place. The surgery involved the metal rod togther with a series of screws and hooks

The vast majority of patients have had excellent results with Harrington rod instrumentation and fusion.However, a few patients develop low back and leg pain decades after their original scoliosis fusion surgery; these problems can also develop in patients who have been fused without the Harrington rod.

The Harrington Implant (or Harrington Rod) was an early medical procedure to treat curvature of the spine (scoliosis) that was intended to give the patient more freedom of movement than previously available. Surgery for the Harrington implant was intensive, and the recovery time, long. The initial course of treatment took several months, and it was often years before a patient was given the "all clear". Developments over the next 10 to 15 years reduced the overall timescale of treatments, but the basic method remained the same.

A patient's experience in the 1960s

These notes refer to the timescales in 1966-70, and are based on the experience of a patient. Patients were initially admitted for two days' observation to ensure they were in good general health. On the third day, they underwent the operation, under full anaesthetic. The rod was fixed in the optimum position for the degree and place of curvature, and fixed securely using a pair of hooks that linked it to the spine. The rod had ratchet ends that fitted through holes in the hooks, and the compression of the spine kept the whole thing in place.

Under anaesthetic, the patient was stretched to straighten the spine, and the ratchet system held everything in its new position. The design also allowed for additional growth in the patient, or post-operative straightening, because as the spine got longer, the ratchet allowed the rod to move in only one direction. Rods came in a variety of lengths from around 10 to 30 cm, depending on the patient's need.

The first stage of post-operative treatment took place at the unit because patients needed to be kept as immobile as possible. They spent two weeks on a "Stryker" bed that allowed the patient to be either flat on their back, or flat on their front. (Stryker is a Canadian trademark covering a variety of specialist orthopaedic beds.) Lying on a side was not allowed, nor was turning from front to back. The bed was designed to allow nursing staff to roll the patient every four hours by strapping on a new section and rotating the whole structure.

At the end of two weeks, or longer, if the surgeon felt it was necessary, the patient was put into a surgical plaster cast, covering at least the length of the spine, and sometimes the neck. After the cast set, the patient was allowed to go home where they spent a further 12 weeks on full bed rest, and told to operate "log roll" conditions. That meant being horizontal at all times no sitting or standing, no more than one pillow, and only bending one leg at once, when lying on the back.

At the end of the 12 weeks, the patient was returned to the unit to spend the next 10 days to 2 weeks learning to walk again.

They faced two main problems:

Having spent more than 3 months in bed, the patient was weak and frequently carrying 10-15 kilograms of plaster;

The patient's spine was frequently a very different shape from before the operation, so balance was difficult. Many felt that they were falling over because they had spent many years, leaning sideways before the operation.

After learning to walk again, the patient was fitted with a surgical corset that had steel-reinforcing rods down the back. This had to be worn for 24 hours a day, and could be removed only for bathing. The time-scale for this stage of the treatment was extremely variable, but rarely less than a year. Termination of the corset-stage began with removal during sleep for a few months, before the patient was allowed to abandon it altogether.

During the treatment, and up to losing the corset, patients were forbidden to undergo any form of physical exercise, including swimming, at least in the late 1960s and early 1970s. As doctors realised that the treatment was quite robust, the restrictions began to be lifted, and the timescale for the whole process reduced.


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