Complications following Harrington instrumentation for fractures of the thoracolumbar spine.

The purposes of using Harrington instrumentation for the treatment of thoracolumbar fractures are to reduce the fracture, decompress the spinal canal, create stability at the fracture site, and shorten the hospitalization period. However, technical problems or the injudicious use of Harrington-instrumentation systems can also complicate the management of these fractures. We have studied forty patients (forty-five Harrington-instrumentation stabilization procedures) who had significant complications. Twenty-six of the thirty patients who were followed for more than two years required additional spinal reconstructive surgical procedures. Five patients had neurological deterioration (one died), nine patients had an inadequate reduction of translational displacement of a vertebral fracture, sixteen patients had dislodgment or disengagement of the Harrington components with resultant loss of fixation, six patients had a deep wound infection, three patients had a complete wound dehiscence with exposure of metal, and sixteen patients had persistent unrecognized neural compression. Several factors were associated with these failures of Harrington instrumentation: translational (flexion-rotation) injuries of the osteoligamentous middle column; failure to obtain either myelographic or computed tomographic studies, or both, postoperatively; failure to identify persistent neural compression; wound dehiscence; the use of distraction rods for high thoracic kyphosis; and instrumentation across the lumbosacral joint.