Degenerative changes of the lumbosacral junction after Risser and Harrington spondylodesis

Introduction: The long-term results of two operation techniques according t o Risser and Harrington were of special interest. As part of this study, se condary changes of the lumbar spine, as well as the lumbosacral junction, w ere evaluated over time. Material and Methods: Two groups of 20 patients, w ho underwent one of the above-mentioned operative procedures for idiopathic scoliosis were analyzed (group A: Risser procedure, average age 15 years; group B: Harrington procedure, 17 years of age). The preoperative deformity ranged between 34 degrees and 108 degrees Cobb angle. The patients were ev aluated at three different points in time: 1) peoperatively; 2) upon the co nclusion of outpatient treatment following the surgery; and 3) between 13 a nd 15 years postoperatively. Results: Degenerative changes, especially spon dylarthrosis of the lumbosacral region, were seen more frequently in the Ha rrington group due to the higher rigidity of the implant and the ensuing in creased loading of the adjacent spinal segments. The comparison of the two procedures revealed that a better primary correction of the deformity was a chieved with the Harrington operation. Moreover, the Risser group showed a higher rate of pseudarthrosis and secondary loss of correction. In the Harr ington group we found a higher rate of degenerative arthritis. Clinical rel evance: A better primary correction of the scoliosis leads to a higher stra in of the lumbosacral junction. The resultant secondary changes (spondylart hrosis) in this period of observation were rarely of clinical relevance. Ne vertheless, whenever possible presacral segments should remain free in the range of a spondylodesis to reduce the loading of the lumbosacral junction.