A new method for the treatment of scoliosis is described in which
a metal system of rods and hooks is implanted, and distraction and
compression forces applied, to correct the curve and stabilize the
treated segments in the corrected position by skeletal fixation.
The technique and principles of this method of treatment and a summary
of the preliminary results are given.
Why was this article selected as a classic
orthopaedic reference?
This article is a landmark, as it begins the modern treatment
of scoliosis with the most important advance since the introduction
of spine arthrodesis at the start of the twentieth century. Dr.
Harrington describes the development of his system, beginning in
1949 through 1954 and modified in 1955 through 1960. I believe that
it is key for young orthopaedists to see how scoliosis treatment
evolved from the idea of an internal brace without fusion to a device
that was meant to help achieve a solid fusion but had to be supplemented
with cast immobilization for many months. While most of us would
no longer use what now appears to be a very simple device, we should
continue to question whether our results justify the increased risk
of neurologic complications and certainly the increased costs associated
with the newer devices.
How has the information in the article withstood the "test
of time"?
Dr. Harrington was a meticulous collector of data, which he presents
in the article. It would be difficult to publish this article today.
The scoliotic curves that were treated had a multitude of etiologies.
Numerous statements and recommendations (e.g., for use of the Harrington
factor) are made without supporting data. The results (or outcomes as
we now term them) are vague, with no real data on durations of follow-up
and so on.
How has our thinking changed with regard to
this subject since the publication of this landmark work?
While the techniques and many of the statements would not be
acceptable today, the article represents the beginning of modern
spinal instrumentation. Our thinking on this subject remains the
same. The goal of scoliosis surgery should be a solid fusion with
as much correction as can be safely obtained.
M.L.E.