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.