Ventral derotation spondylodesis. A review of 22 cases

Twenty-two patients with major lumbar or thoracolumbar curves were treated with Zielke's modification of the Dwyer instrumentation, termed the "ventral derotation spondylodesis (VDS) system. In 16 patients, this was followed by planned second-stage posterior Harrington instrumentation and fusion. Six patients with adolescent idiopathic scoliosis were treated with VDS instrumentation and fusion alone. In neuromuscular and adult idiopathic scoliosis, a combined approach resulted in excellent curve correction and a high rate of successful fusion. In adolescent idiopathic scoliosis, VDS instrumentation alone resulted in excellent curve correction while permitting a shorter fusion length than conventional posterior Harrington instrumentation.     

Adult idiopathic scoliosis treated by posterior spinal fusion and Harrington instrumentation

Ninety-one patients with idiopathic scoliosis, who underwent posterior spinal fusion and instrumentation from January 1977 to December 1982, were reviewed. All patients were 20 years or older at the time of surgery and none had undergone a prior surgical procedure. Indications for surgery included pain, progressive deformity, and pulmonary symptoms. All patients had a posterior spinal fusion with Harrington instrumentation and autogenous iliac bone graft, with the addition of segmental wiring in only eight. No patient had an anterior fusion or fusion to the sacrum. Follow-up averaged 3.5 years (range: 2-7 years). The average correction at the time of surgery was 38%, and 32% at the time of last follow-up. Seventy-nine percent of the patients reported complete relief of the symptom(s) for which they had surgery. There were 34 complications in 30 (33%) patients. Pseudarthrosis occurred in 14 (15%), requiring 15 additional procedures to achieve a solid arthrodesis. Urinary tract infection occurred in 8 (9%) patients and Harrington hook dislodgement in 5 (5%). One patient sustained a partial paraparesis with recovery to a minimal deficit. No deaths occurred. Although largely successful, posterior fusion with Harrington instrumentation for adult scoliosis has a significant incidence of pseudarthrosis and instrumentation problems.     

Surgical management of paralytic scoliosis in myelomeningocele

A retrospective analysis of 54 patients with paralytic scoliosis due to myelomeningocele, who underwent surgical treatment, was performed. The aim of this study was to compare different surgical techniques and to identify clinical parameters influencing primary and midterm results. Three surgical techniques were used: 1) group I, posterior fusion/instrumentation; 2) group II, anterior fusion/no instrumentation combined with posterior fusion/instrumentation; and 3) group III, anterior and posterior fusion/instrumentation. Average age at surgery was 13.1 years. A preoperative scoliosis angle of 90 degrees [interquartile range (25th-75th percentile) (IQR), 76-106 degrees] was primarily reduced to 38 degrees (IQR, 30-50 degrees). At final follow-up (mean, 3.3 years), correction deteriorated to 44 degrees (IQR, 38-65 degrees). The group III procedure resulted in a better midterm correction of scoliosis compared with group I (P = 0.02). The extension of anterior fusion correlated with primary and midterm correction of scoliosis (P < 0.03). Patients with a thoracic level of paralysis had a higher relative loss of correction compared with patients with a lumbar level (P < 0.06). This finding can be attributed mostly to group I patients (P = 0.011). Hardware complications occurred in 16 patients (30%). Relative loss of correction among these patients was high (P < 0.01) and relative midterm correction low (P = 0.001). We recommend anterior and posterior fusion, each with instrumentation for the treatment of paralytic scoliosis in myelomeningocele. In patients with a thoracic level of paralysis, the two-stage procedure is mandatory to reduce the risk of hardware complications and subsequent major loss of correction.     

Techniques of internal fixation for degenerative conditions of the lumbar spine

The indications and techniques for internal fixation of the lumbar spine in degenerative conditions have changed drastically since internal fixation was first applied to the spine almost 100 years ago. Anterior instrumentation and fusion may be used for repair of pseudarthrosis after posterolateral fusion; symptomatic lumbar scoliosis associated with degenerative disc disease; late pain secondary to posttraumatic kyphosis; postlaminectomy instability; and lumbar pain secondary to thoracolumbar kyphosis. Posterior instrumentation and fusion has been performed with Luque instrumentation over 3-4 levels in cases of multilevel instability. Combined anterior and posterior instrumentation and fusion are required for lumbosacral fusion in lumbar scoliosis with degenerative disease, and surgical correction of postsurgical lumbar kyphosis (flat-back syndrome). The techniques are demanding but with attention to detail can be performed with acceptably low-complication rates.     

Scoliosis surgery in neurofibromatosis

Twenty-three patients who were treated by posterior spinal fusion with neurofibromatous scoliosis were reviewed to study the adequacy of spinal fusion, rate of pseudarthrosis, and incidence of complications. Twenty patients achieved a solid fusion with posterior surgery alone. Thirteen patients required one or more posterior augmentation procedures because of progressive deformity. Three patients with dystrophic kyphoscoliosis required an anterior spinal fusion in addition to the posterior fusion to achieve a solid fusion mass. The type of graft material, Harrington instrumentation, and degree of kyphosis or scoliosis had no effect on the rate of pseudarthrosis. Preoperative neuroradiographic evaluation was found to be warranted for all patients with neurofibromatous scoliosis.     

Posterior spinal fusion in paralytic scoliosis and myelomeningocele

The Shriners Hospital, Lexington, KY, experience with posterior spinal fusion for scoliosis in 50 patients with myelomeningocele was reviewed. Six patients were fused with Harrington rods and 47 of 50 patients were treated with some form of segmental fixation. The complication rate was 48% (24/50) resulting in 1.48 procedures per patient. The deep infection rate was 8% (4/50) and the pseudarthrosis rate was 16% (8/50). The use of modern segmental instrumentation systems has improved the pseudarthrosis rates for posterior spinal fusion in scoliosis associated with myelomeningocele but not to the point of displacing the current approach of an anterior and posterior spinal fusion.     

The Cotrel-Dubousset system--results in spinal reconstruction. Early experience in 47 patients.

Forty-seven patients were treated with spinal fusion and Cotrel-Dubousset instrumentation and were followed for an average of 28 months. Spinal procedures included: 1) posterior spinal fusion for idiopathic scoliosis (26 patients); 2) posterior pseudarthrosis repair (5 patients); 3) combined anterior/posterior fusion to the sacrum (6 patients); and 4) combined anterior/posterior osteotomies (10 patients). Group 1: Partial derotational correction was achieved for adolescent idiopathic scoliosis. Group 2: Successful pseudarthrosis repair was achieved in four patients. Group 3: A solid arthrodesis was obtained in two patients, whereas the other three patients underwent revision of sacral screw fixation for pseudarthrosis. One patient died postoperatively. Group 4: Pain relief and a balanced correction was achieved in all patients. The Cotrel-Dubousset system appears to be a versatile system and provides a wide range of possibilities for a variety of spinal problems.     

The timing of spinal fusion in adolescent idiopathic scoliosis

102 cases of idiopathic adolescent scoliosis seen over a period of 5 years were studied. 59 patients who were treated surgically and followed up for a minimum of 48 months, fell into one of two groups: Group I - those operated on within 3 years following the adolescent growth spurt, and Group II - those who were operated on at or after skeletal maturity. 35 patients were treated by Harrington instrumentation and posterior fusion and 24 by Harrington instrumentation, segmental sublaminar wiring and posterior fusion. In 7 patients anterior release was performed initially. In Group I, the extent of deformity correction and elimination of the rib hump were better, and complications such as neurological deficit, hook dislodgement and implant breakage were encountered less frequently. Harrington instrumentation, segmental sublaminar wiring and posterior fusion gave better results than instrumentation and fusion. Our results suggest that surgical correction should be done within 3 years following growth spurt, i.e. 14 to 16 years of age.     

Degenerative changes of the lumbosacral transition after Risser and Harrington spondylodesis

INTRODUCTION: The long-term results of two operation techniques according to Risser and Harrington were of special interest. As part of this study, secondary changes of the lumbar spine, as well as the lumbosacral junction, were evaluated over time. MATERIAL AND METHODS: Two groups of 20 patients, who 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 evaluated at three different points in time: 1) preoperatively; 2) upon the conclusion of outpatient treatment following the surgery; and 3) between 13 and 15 years postoperatively. RESULTS: Degenerative changes, especially spondylarthrosis of the lumbosacral region, were seen more frequently in the Harrington group due to the higher rigidity of the implant and the ensuing increased loading of the adjacent spinal segments. The comparison of the two procedures revealed that a better primary correction of the deformity was achieved with the Harrington operation. Moreover, the Risser group showed a higher rate of pseudarthrosis and secondary loss of correction. In the Harrington group we found a higher rate of degenerative arthritis. CLINICAL RELEVANCE: A better primary correction of the scoliosis leads to a higher strain of the lumbosacral junction. The resultant secondary changes (spondylarthrosis) in this period of observation were rarely of clinical relevance. Nevertheless, whenever possible presacral segments should remain free in the range of a spondylodesis to reduce the loading of the lumbosacral junction.     

Comparison of anterior and posterior double-rod instrumentation for thoracic idiopathic scoliosis: results of 141 patients

Ventral derotation spondylodesis, according to Zielke, achieves good results in operative treatment of idiopathic thoracic scolioses. Corrections of scoliotic major and secondary curve as well as derotation of the spine are reliably performed. The high rate of rod fractures with subsequent correction loss as well as a proportionate kyphogenic effect represents a problem. By keeping to the correcting principle, anterior double-rod instrumentation (Halm-Zielke Instrumentation) is to be stable in a similar way as posterior double-rod systems. Thus, it is done to facilitate brace-free postoperative care and to prevent excessive kyphotic pattern of the spine. In this prospective study, we retrospectively collected data. We performed radiological follow-up of two groups of patients with idiopathic thoracic scoliosis (King II, III and IV) undergoing an operation with posterior approach (USS instrumentation, posterior group, n=104) in 1997 and 1998 or being corrected with an anterior fusion (Halm-Zielke instrumentation, anterior group, n=37) between 2000 and 2001. Mean age of all patients for operation was 15±4 years. Follow-up was performed after 4±2 years on average. Preoperative measurements of the major and secondary curve, the lateral profile, rotation and frontal balance (C7 to S1) did not show any significant differences apart from a more severe scoliotic curve in the lumbar spine for the anterior group with appropriately higher lumbar rotation. During follow-up we noticed similar corrections of the thoracic major and lumbar curve in both groups ranging from 49 to 56%. In case of hypokyphotic (T4–T12≤20°) scoliosis a kyphogenic effect on the thoracic spine was achieved with both surgical methods. Hyperkyphotic (T4–T12≥40°) scolioses were flattened by posterior spinal fusion; the effect of anterior spinal fusion was not significant. Correction of thoracic and lumbar rotation in the anterior group by 37 or 30% was more significant than in the posterior group by 27 or 20%. There was no impact of anterior technique on the balance of the spine whereas the latter shifted by an average of 7 mm to the left in the posterior group. The number of fused segments was significantly smaller in the anterior group with 7±1 vertebral bodies (posterior, 11±1 vertebral bodies). Rates of complication were identical with 11 or 12% in both groups during follow-up. Anterior and posterior double-rod instrumentations result in comparable corrections for idiopathic thoracic scoliosis of the major and secondary curve. In case of posterior technique, however, four vertebral bodies less were integrated in spondylodesis on average. Balance of the spine did not change after anterior spondylodesis; however, it declined by using the posterior technique. Augmentation of the anterior threaded rod combined with a solid second rod significantly decreases the rate of implant breakages and reliably reduces consecutive correction losses.     

TSRH内固定治疗脊柱侧凸

目的　回顾性研究TSRH(TexasScottishRiteHospital)脊柱内固定系统在治疗脊柱侧凸的临床疗效。 方法　对 1998年 1月至 2 0 0 0年 12月手术治疗的 12 9例脊柱侧凸患者 ,总结其侧弯矫形、脊柱平衡、并发症及 3年以上的随访结果。根据手术方法不同 ,共分为 4组。A组 :单纯脊柱后路融合固定术 ;B组 :单纯脊柱前路融合固定术 ;C组 :分期前、后路融合固定术 ;D组 :Ⅰ期前、后路融合固定术。四组患者均应用TSRH内固定系统。手术时平均年龄 14 .2岁 (6～ 5 5岁 ) ,平均随访 34个月。结果　A组 :78例病人行单纯脊柱后路融合TSRH内固定 ,术后平均矫形率为6 3.4 %。随访 38个月 (2 4～ 5 0个月 ) ,平均矫形丢失 7°,矫形丢失率平均 9.5 %。本组并发症发生率为 12 .8% ,包括 3例脱钩 ,3例螺钉断裂 (共 6枚螺钉 ) ,1例术后侧弯失代偿 ,1例术后发生曲轴现象。B组 :2 2例患者行单纯脊柱前路融合、短节段TSRH内固定 ,平均矫形率为 74 .8%。平均随访 36个月 ,平均矫形率丢失 5 %。 2例发生一过性交感神经损伤。术后 6个月内均自然恢复。C组 :17例有 90°以上的侧弯 ,且Bending像上侧弯仍大于 7°的患者行前路松解 ,2～ 3周后再行后路融合TSRH内固定。本组平均手术时间 8.3h ,出血 935ml,输血 6 83ml,平均矫形 33.6°,矫     

Irradiation induced kyphosis.

Eighty-one patients with Wilms tumor treated by irradiation and chemotherapy were studied. Despite the fact that multiple portals for irradiation were used, each crossing the midline, the amount of irradiation delivered to different parts of the vertebral body varied and it was this variation in delivered dose which produced axial skeletal deformities in 70% of the patients. Of the 57 patients with these deformities 32 had scoliosis, 22 kyphoscoliosis and 3 patients pure kyphosis; 12 patients had a kyphotic deformity of over 25 degrees, 7 patients requiring surgical correction. A high incidence of pseudarthrosis following posterior fusion has led to the preference of a 2-stage procedure, anterior interbody fusion followed by a posterior fusion with Harrington rods after 2 weeks of correction in halo femoral traction.     

Ventrale Skolioseoperationen

For more than 2 decades ventral derotation spondylodesis (Zielke VDS) as a major improvement over Dwyer instrumentation (DI) was the gold standard of instrumented curve correction and stabilization from the anterior approach. As the first available system it enables a true three-dimensional curve correction. A disadvantage is the low internal stabilization capability with a need for long-term external stabilization by means of cast and brace treatment postoperatively. Meanwhile with the development of modern single and dual solid rod systems these disadvantages can be avoided completely. Video-assisted (thoracoscopic) anterior scoliosis surgery accounts for less than 2% of anteriorly treated scoliosis cases, mainly due to a long operating time and significant learning curve. From the posterior approach the Cotrel-Dubousset instrumentation (CDI) as a polysegmentally attached posterior hook threaded dual rod system used to be state of the art for a long time, since it eliminated the disadvantages of Harrington instrumentation (HI) in terms of only one-dimensional correction and low stabilization capabilities. However even with CDI effective derotation was impossible. In posterior scoliosis surgery there is a strong trend away from hook systems towards transpedicular segmentally fixed dual rod systems not only in the lumbar spine but also in the thoracic area. Advantages of these newer techniques are shorter fusion, improved correction, and less loss of correction over time. Advantages of modern anterior instrumentation systems in comparison to posterior transpedicular instrumented dual rod systems are less blood loss, better derotation, slightly shorter fusion levels, and a better influence on sagittal plane control or improvement especially for hypokyphotic thoracic scoliosis cases. Our data also document a superior spontaneous correction of the lumbar curve after selective anterior instrumented correction (Lenke 1B+C), although other studies could not find significant differences. In our experience the neurological risk of anterior instrumented correction is also lower than that of posterior scoliosis surgery, although the morbidity and mortality data of the Scoliosis Research Society could not prove that anymore in recent years. A negative effect of anterior transthoracic scoliosis surgery in comparison to posterior surgery is a more negative effect on lung function, which improves slower after surgery and does not quite reach the levels of posterior surgery at follow-up. But new data on posterior segmental transpedicular correction and fusion also prove a lordosating effect with negative effect on lung function.     

Combined anterior and posterior fusion for spinal deformity in myelomeningocele

Since 1973, 50 of 54 children have been treated by the author with a combined anterior and posterior fusion. Twenty males and 34 females, ranging in age from 1 to 16 years, have been followed for a mean period of 5.5 years. Sixteen patients with a kyphosis averaging 113 degrees (range, 77 to 170 degrees) had correction of deformity to a mean of 35 degrees. Thirty-seven patients with a scoliosis averaging 73 degrees (range, 20 to 135 degrees) had correction to an average of 34 degrees (range, 0 to 75 degrees). There were 4 cases of deep wound infection successfully treated with drainage and antibiotics and only one case required implant removal after fusion/maturation. A pseudarthrosis was noted by radiograph in 6 patients, 3 of whom had isolated asymptomatic lumbosacral pseudarthroses. Three patients had pseudarthrosis at the thoracolumbar junction. These required repair and were successfully treated by supplemental posterior fusion resulting in an overall pseudarthrosis rate of 5.7%. Anterior fusion of the dysraphic spine allows greater correction of both spinal deformity and pelvic obliquity in addition to contributing significant strength to the fusion mass. Segmental spinal instrumentation with sublaminar and pedicular wiring to custom-contoured Luque rods provides excellent correction and immediate postoperative stability.     

Combined staged anterior and posterior correction and fusion of the spine in scoliosis following poliomyelitis.

The problems with severe forms of scoliosis following poliomyelitis include the associated muscle imbalance, soft tissue contractures and pelvic obliquity. Such deformities militate against optimal correction and maintenance of that correction and their treatment is often marred by pseudarthroses. Seventeen patients with an average curve of 93 degrees have been treated and followed for up to 38 months. Preliminary traction was used in 8 patients, then a staged anterior and posterior correction and fusion was done, using Dwyer's instrumentation of the major curve in all and a Harrington rod to supplement the posterior fusion in eleven patients. With this technique the major curve was corrected by 80 per cent with an average 2 per cent loss over 18 months. No pseudarthroses were seen when the Harrington rod was used. Great care must be taken if halo-pelvic traction is to be used for patients with pelvic obliquity, for preliminary correction halo-femoral traction will often be adequate. In the more severe forms of paralytic scoliosis a combined staged anterior and posterior correction and fusion should be considered if the aim is maximal correction of the scoliosis and avoidance of pseudarthroses.     

Results of Harrington instrumentation and fusion in the adult idiopathic scoliosis patient.

Between January 1961 and December 1972, 132 patients over twenty years old with idiopathic scoliosis were surgically treated using Harrington instrumentation and fusion techniques. All patients were seen by us because of curve magnitude or symptoms secondary to scoliosis. The average correction obtained at operation was 48 per cent. Twenty-four patients had early complications. Fifty-two had late complications, the most frequent of which was pseudarthrosis. The majority of patients had significant improvement in symptoms as a result of surgical correction and stabilization.     

Thoracolumbar scoliosis in cerebral palsy. Results of surgical treatment.

Of 294 patients with cerebral palsy seen from 1960 to 1972, forty-two had clinically significant lumbar and thoracolumbar scoliosis (31 to 135 degrees) and thirty-three were treated by spine surgery: ten by Harrington instrumentation and posterior spine fusion, eighteen by the Dwyer procedure and anterior fusion, and five by a two-stage combined anterior and posterior fusion. Evaluation of the results after eighteen to sixty-eight months showed: relief of pain in seventeen cases, improved sitting tolerance in seventeen, less nursing care needed in three, less equipment required in six, ability to use equipment providing more function in three, placement in a facility where less care was required in two, and improved eating patterns in two. Only the combined procedure appeared to give adequate correction and a low incidence of pseudarthrosis.     

Comparison of anterior and posterior instrumentation for correction of adolescent thoracic idiopathic scoliosis

STUDY DESIGN: This was a prospective study of two cohort groups of patients (one group receiving anterior instrumentation and the other posterior instrumentation) receiving treatment for thoracic idiopathic scoliosis. OBJECTIVE: To present the 2-year postoperative results of a prospective multicenter study comparing the use of anterior instrumentation with that of posterior multisegmented hook instrumentation for the correction of adolescent thoracic idiopathic scoliosis. SUMMARY OF BACKGROUND DATA: Despite reports of satisfactory results, problems have been reported with posterior systems, including worsening of the lumbar curve after surgery and failure to correct hypokyphosis. Theoretically, the advantages of anterior instrumentation include prevention of lumbar curve decompensation by shortening the convexity of the thoracic curve. In addition, by removing the disc, better correction of thoracic hypokyphosis could be obtained. METHODS: Seventy-eight patients who underwent an anterior spinal fusion using flexible threaded rods and nuts (Harms-MOSS instrumentation, De Puy-Motech-Acromed, Cleveland, OH) were analyzed and compared with 100 patients who underwent posterior spinal fusion with multisegmented hook systems. Parameters of comparison included coronal and sagittal correction, balance, distal lumbar fusion levels, and complication. All patients had idiopathic thoracic curves of King Types II to V. The average age at surgery was 14 years in each group, the average preoperative curve 57 degrees, and the minimum duration of follow-up for all patients 24 months. All data were collected prospectively and analyzed via Epl into statistical analysis (Centers of Disease Control, Atlanta, GA). RESULTS: Average coronal correction of the main thoracic curve was 58% in the anterior group and 59% in the posterior group (P = 0.92). Analysis of sagittal contour showed that the posterior systems failed to correct a preoperative hypokyphosis (sagittal T5 to T12 less than 20 degrees) in 60% of cases, whereas 81% were normal postoperatively in the anterior group. However, hyperkyphosis (sagittal T5 to T12 greater than 40 degrees) occurred after surgery in 40% of the anterior group when the preoperative kyphosis was greater than 20 degrees. Postoperative coronal balance was equal in both groups. An average of 2.5 (range, 0-6) distal fusion levels were saved using the anterior spinal instrumentation according to the criteria used for determining posterior fusion levels in this study. Selective fusion of the thoracic curve (distal fusion level T11, T12, L1) was performed in 76 of 78 patients (97%) in the anterior group as compared with only 18 of 100 (18%) in the posterior group. Surgically confirmed pseudarthrosis occurred in 4 of 78 patients (5%) in the anterior group and in 1 of 100 patients (1%) in the posterior group (P = 0.10). Loss of correction greater than 10 degrees occurred in 18 of 78 patients (23%) in the anterior group and in 12 of 100 patients (12%) in the posterior group (P = 0.01). Implant breakage occurred in 24 patients (31%) of the anterior group and in only 1 patient (1%) of the posterior group. CONCLUSIONS: 1) Coronal correction and balance were equal in both the anterior and posterior groups, even though the anterior group had the majority of curves (97%) fused short or to L1, whereas only 18% were fused short or to L1 in the posterior group. 2) In the anterior group there was a better correction of sagittal profile in those with a preoperative hypokyphosis less than 20 degrees. However, hyperkyphosis (with a mean of 54 degrees) occurred in 40% of those in the anterior group with a preoperative kyphosis of more than 20 degrees. 3) An average of 2.5 lumbar levels can be saved with anterior fusion and instrumentation according to the criteria used for choosing posterior fusion levels in this study. 4) Using the 3.2-mm flexible rod in this study, loss of correction, pseudarthrosis, and rod breakage were unacceptably highe     

各型内固定矫形术治疗脊柱侧凸效果评价

目的评价不同内固定矫形术治疗脊柱侧凸的效果。方法对１９８４～１９９７年用不同手术方法矫治１２５例１００°以内脊柱侧凸患者的治疗和随诊资料进行研究,手术方法包括Ｈａｒｉｎｇｔｏｎ、Ｌｕｑｕｅ、联合ＨａｒｉｎｇｔｏｎＬｕｑｕｅ、ＣＤ、Ｚｉｅｌｋｅ、前路松解加后路手术和俄式手术等,对不同方法的优缺点及各自的矫正情况、身高变化、手术时间、术中输血量、住院时间、术后并发症和矫正度丢失情况及其原因进行比较分析。结果Ｈａｒｉｎｇｔｏｎ法矫正效果比其它方法差而且并发症多;Ｌｕｑｕｅ法费时且有潜在脊髓损伤之忧;ＣＤ法有三维矫正作用,矫正效果好,未见脱钩、断棍;含前路手术的方法远期Ｃｏｂｂ角度丢失少,其中前路松解加后路手术（ＣＤ术）方法简便易行,效果好;俄式手术作为一种探索中的不影响脊柱生长发育的新型脊柱侧凸内固定矫形术,有一定优越性。结论在不进行脊柱融合的新技术发展成熟前,ＣＤ术对生长发育中的青少年脊柱侧凸患者是一种较好的治疗方法     

Surgical management of adult scoliosis

In a retrospective analysis of 62 adult scoliotic patients with an average age of 34 years, 39 patients were treated by single-stage posterior fusions, 19 by Harrington instrumentation, and 20 by Luque instrumentation. Twenty-three patients had staged scoliotic procedures. Overall there was a 47% incidence of complications, with the lowest rate, 20%, found in those patients undergoing single-stage posterior fusion with Luque instrumentation. A 16.7% incidence of pseudarthrosis was found in those patients undergoing posterior fusion with Harrington instrumentation. Pseudarthrosis was not found in patients fused posteriorly with Luque instrumentation or with staged anterior and posterior instrumentation.