Benutzer:THWZ/Baustelle/Harrington-Stab
Der Harrington-Stab (in der englischsprachigen Fachliteratur Harrington Rod oder Harrington Implant) ist ein chirurgisches Implantat aus rostfreiem Stahl. Der Stab wurde entlang der Wirbelsäule implantiert um Verbiegungen der Wirbelsäule, in erster Linie die Skoliose, zu behandeln. Von den frühen 1960er Jahren bis in die späten 1990er wurde das Implantat bei etwa einer Million Skoliose-Patienten eingesetzt. Die Entwicklung neuer, effektiverer Implantate zur Wirbelsäulenkorrektur hat den Harrington-Stab mittlerweile aus dem klinischen Einsatz verdrängt.
Geschichte
Paul Harrington, ein Orthopäde in Houston/Texas, entwickelte diese Behandlungsmethode im Jahr 1953.
Ziel der Behandlung war es, die Krümmung der Wirbelsäule zu reduzieren und durch Stabilisierung eine Einsteifung der Wirbelsäule sicher zu stellen. Vor der Entwicklung des Harrington-Stabes wurden die Wirbelsäulen von Skoliose-Patienten ohne jeglichen operativen Eingriff fusioniert (eingesteift); zu diesem Zweck war über viele Monate das Tragen eines Gipsverbandes erforderlich, dennoch verblieben starke, fortschreitende Verkrümmungen der Wirbelsäule.
Purpose
Harrington rod instrumentation is used to treat instability and deformity of the spine. Instability occurs when the spine no longer maintains its normal shape during movement. Such instability results in nerve damage, spinal deformities, and disabling pain. Spinal deformities may be caused by birth defects, fractures, marfan syndrome, neurofibromatosis, neuromuscular diseases, severe injuries, and tumors. By far, the most common use for the Harrington Rod was in the treatment of scoliosis, for which it was invented.
Description
The device itself was a stainless steel distraction rod fitted with hooks at both ends and a ratchet and was implanted through an extensive posterior spinal approach, the hooks being secured onto the vertebral laminae. It was used at the beginning without performing a spinal fusion but early results proved fusion as part of the procedure was mandatory, as movement of the unfused spine would cause the metal to fatigue and eventually break. The procedure required the use of a postoperative plaster cast or bracing until vertebral fusion had occurred.
Flatback Syndrome caused by lumbar fusion using a Harrington Rod
Flatback Syndrome is a problem that develops in some patients treated with Harrington Rod instrumentation, where the rod extends down into lower part of the lumbar spine. Because the Harrington could not follow the natural lordosis of the lower back (ie the backwaist curve), the spine was straightened out into an unnatural position. At first, the unfused spinal segments would compensate for the straightening effects, but eventually the discs would degenerate and wear down. The patient then develops back pain, difficulty standing upright, and experiences limitations when walking. Eventually, the problem requires surgery to realign the spine.
As exemplified by Pecina & Dapic in the European Spine Journal Feb 2007, Flatback Syndrome is not inevitable and does not happen to every person with a low Harrington Rod instrumented fusion; there are many people who have had Harringtons for decades with no adverse effects.
References
- Living with cerebral palsy
- Medscape - Modern Posterior Thoracic Instrumentation
- - 20-year follow-up of Harrington instrumentation in the treatment of severe Idiopathic Scoliosis, Pecina & Dapic, European Spine Journal Vol 16 No 2 Feb 2007(subscription only)
- - Scoliosis Surgery: Flatback Syndrome and Surgery, by Baron S. Lonner MD, Director of Scoliosis Associates in New York
[[Category:Implants]] [[Category:Orthopedic surgery]]
