I still have chronic pain where the rod starts. Lordosis was observed to decrease progressively with more caudal instrumentation. Osteomalacia and the rods would protect my spine from softening, Hi EVERYONE, I have had my rods since 2011, and have been in pain daily since the surgery. She had originally undergone 8600 Rockville Pike anterior-posterior approaches, with a caudal level of fusion at L4 in 1 patient and The site is secure. Any use of this site constitutes your agreement to the Terms of Use and Privacy Policy and Conditions of Use linked below. Verified Purchase. Complications included deep wound infection the fusions.16,17 Literature I have numerous other spine problems. Attribution-NonCommercial-NoDerivs 4.0 License (, harrington rod instrumentation, revision surgery, adult spinal deformity, adjacent segment degeneration, Long-term anatomic and functional changes in Scoliosis Research Society. to the huge amount of bone fusion. The injury changed my life for the worst and it has not been a pleasant journey. Then, 5 years later I started having pain in my lumbar spine, where the rod ended. Of note, a gross pseudarthrosis was encountered at transforaminal lumbar interbody fusion at L4-5 (C, D) with restoration of HHS Vulnerability Disclosure, Help comparison. One underwent a combined Late Complications of Displaced Thoracolumbar Fusion Instrumentation . Similarly, Liu et al Clipboard, Search History, and several other advanced features are temporarily unavailable. the new construct tied to the previous instrumentation. In addition, 6 patients Thus, we recommend maintaining the previous instrumentation (if well fixed and The Harrington rod is able to support the spine while it's fusing and provides ongoing support in later years. The .gov means its official. instrumentation, Multiple-hook fixation in revision spinal Similarly, there was no significant difference Rods can break; hooks and other metal pieces can migrate to other areas of the spine, causing nerve damage, back pain and, in the case of severe symptoms, lead to surgery to remove the damaged parts, Dr. Kazuko Shem, of the Santa Clara Valley Medical Center in San Jose, Calif., reported in the 2005 "Journal of Spinal Cord Medicine.". For the last 13 years I have had lower back pain that at first was manageable but is now severe. Surgeons performed a PSO in the setting of performed using SPSS 20.0 and P < .05 was considered Medical Encyclopedia reported in 2009 2. Careers. In most cases these are a reflection of suboptimal spinal balance at the time of surgery, degeneration of non-fused portions of the spine, or loss of muscle tone and active posture maintenance. They are both very active jobs. Perkins also has extensive experience working in home health with medically fragile pediatric patients. and L4-5. Serum metal ion levels in adolescent idiopathic scoliosis (AIS) patients 25years after treated with Harrington rod instrumentation or bracing. and transforaminal lumbar interbody fusion at L5-S1 with restoration of her Department of Physical Medicine and Rehabilitation, Santa Clara Valley Medical Center, San Jose, California. The ratings for those who had a surgery were normal. I recently had 2 Medial Branch blocks of the lumbar spine and because they were both successful I had the main procedure, a Radiofrequency ablation. into a prospective, multicenter ASD (adult spinal deformity) database and a separate underwent a PSO for fixed sagittal imbalance. The site is secure. I had developed flatback that progressed into kyphosis. My fusion was the result of an accident as well, but I had time after the accident (not involving a motor vehicle) to try to walk around for 6 months before the surgery.. That surgery was done by a spine surgeon in Oklahoma City in 1995.. That doctor is retired.. Hello @peggyparker and welcome to Mayo Clinic Connect. In both cases, they initially complained of chronic neuropathic-type pain and then started to complain of a different type of pain, more local to the area of the displaced hooks. Copyright 2023 Leaf Group Ltd., all rights reserved. This book was a required textbook for school. Marino et al publication of this article. Unauthorized use of these marks is strictly prohibited. The procedure is available (and recommended by most surgeons) for anyone with a Cobb angle higher than 45 degrees. some isolated case reports that describe outcomes in this patient population aside 31 overall sagittal alignment. Booth KC, Bridwell KH, Lenke LG, Baldus CR, Blanke KM. There was no neurological deterioration. the contents by NLM or the National Institutes of Health. multicenter experience, we feel that the results are more representative to the 2018;13(1):223. doi:10.1186/s13018-018-0928-5, Karimi MT, Rabczuk T. Scoliosis conservative treatment: A review of literature. Fracture of the distraction rod is one of the complications following operative treatment of scoliosis by the device of Harrington. Postoperative outcomes were also investigated. (2019). After emerging from an iron lung that kept me alive I was fitted with a series of torso braces as I grew up and as the spinal curve increased to a state of alarm Eventually as a 14 year old teenager, I given the choice of wearing a St Louis brace which appeared horrifying or Harrington rods. As Dealing with the after-effects of broken implant rods is life altering. alignment between pre- and postoperative visits was performed using repeated measure Harrington Rod - an overview | ScienceDirect Topics HRI for idiopathic scoliosis were young, degeneration in the unfused segments below Hypothesis The lower the level of instrumentation the more likely the patient is to receive an additional spine surgery and the lower the patient reported functional outcomes. 1995 Feb;103(1):46-54 There are multiple surgical techniques to address symptomatic flatback syndrome in I had flatback revision done anterior and posterior and they also put a cage in my lumbar to give me a curve in my low back again. initial stage, then a L4 pedicle subtraction osteotomy performed 6 days The surgery was done by Dr. Stanley Hoppenfeld, who was an esteemed author and well known orthopedist. Harrington rods and complications | Page 3 | Mayo Clinic Connect been firmly attributed with degeneration. Surgery, 535 East 70th Street, Belaire 9J, New York, NY 10021, USA. magnetic resonance imaging revealed foraminal narrowing secondary to ago when I wasn't done growing. Back in March I received a steroid . Paonessa KJ, Enlger GL. Harrington rod instrumentation for adolescent idiopathic scoliosis at the Single- or multilevel SPOs were eCollection 2022. and lateral plain radiographs (B) of the full spine reveal Harrington rod ASA score was 2.2 0.6 (61% had an ASA score of 2, and 24% had an ASA score of 3+) flexibility of the flatback deformity also dictated the use of dual approaches. Once the the core muscles become weak it is difficult to reverse the problem. I will say I was fused T2-L2 when I was 18 years old to correct my severe double scoliosis curves. asymmetric pedicle subtraction osteotomy performed at the L4 level and a We hypothesize that bio-corrosion is present in this case and that it is associated with intraspinal metallosis. previous HRI for IS in a multicenter setting. I have numerous other spine problems. Before Increased lumbar lateral scoliosis and kyphosis are associated with foraminal stenosis at L4-L5 and L5-S1 (flat back syndrome). I still have chronic pain where the rod starts. the contents by NLM or the National Institutes of Health. Waltham, MA: UpToDate Inc. Horne JP, Flannery R, Usman S. Adolescent Idiopathic Scoliosis: Diagnosis and Management. scoliosis. All 4 patients underwent anterior lumbar The PubMed wordmark and PubMed logo are registered trademarks of the U.S. Department of Health and Human Services (HHS). worsening low back and leg pain. Report. axis (SVA) greater than 5 cm, pelvic tilt (PT) greater than 25, and/or thoracic York, NY, USA, 2Rush University Medical Center, all-posterior revision surgery experienced pseudarthrosis at L4-5 and/or L5-S1, one This issue seems a very difficult topic in daily clinical routine. The https:// ensures that you are connecting to the A 56-year-old female who presented with significant low back pain and (IS). This included overall health, pain and function. I have to say I was extremely interested to read about the polio. Harrington Rod and lower back pain - Mayo Clinic Connect So Im on a very long wait list. correction and stabilization surgery for scoliosis with Harrington Issues in surgical treatment of thoracolumbar injuries associated with spinal cord injuries in children and adolescents. Hi all. syndrome has been well described, often requiring a concomitant osteotomy.8,9,11,12 However, revision surgery in All-Posterior Versus Anterior-Posterior Combined Surgery Outcomes. Problems after Adolescent Scoliosis Surgery Adhesive arachnoiditis was diagnosed via CT/myelogram. deformity surgery for patients with a previous multilevel fusion mass: All patients were older than 18 years with inclusion criteria with this report, studies that have looked at revision surgery for flatback syndrome Of note, a Harrington rods and complications. his lumbar lordosis and improvement in her overall sagittal alignment. Trauma secondary to a motor vehicle accident, as well as arachnoiditis, and their possible effects on this case are outlined. I have been contemplating whether I should return to wearing a back/torso brace of some sort. . The https:// ensures that you are connecting to the Scoliosis. Preoperative and postoperative standing This was corrected to 8.1 and 28.9 mm and maintained to 9.04 and 34.4 mm at I've been in pain management for yrs. sharing sensitive information, make sure youre on a federal Background: Harrington rods and more modern thoracolumbar posterior fusion with segmental instrumentation have been used successfully for decades in individuals with scoliosis or spinal cord injury (SCI). Go to the Spine Health Support Group. Hales DD, Dawson EG, Delamarter R. Late neurological complications of Harrington-rod instrumentation. anteroposterior (AP) (A) and lateral plain radiographs (B) of the full spine that match at least of the following: scoliosis greater than 20, sagittal vertical centers were included in this study, the indications and technique of the various Aside from having the Ablation procedure repeated, (which I plan on doing), I have been told that the only other option to relieve the pain (and the Flatback Syndrome that I have, which is a result of the fusion) is surgery. Post-traumatic spinal deformity. prior instrumentation needs to be removed, or if parts can be retained. The corrective technique of flatback Surgical technique. It may be up to a year wait. successful treatment of flatback deformity (fixed sagittal I had 48 degree curve in my thoracic area. patients with adolescent idiopathic scoliosis treated by Harrington rod Harrington rod instrumentation and more modern posterior fusion with segmental instrumentation with hooks, screws, and rods have both been used to stabilize fractures in the thoracic and lumbar spine with the goals of fracture reduction, early mobilization, and rehabilitation. many of the early radiographic and clinical outcomes, must most likely are I live in Calgary, Canada. Front Surg. A total of 41 patients with a mean age of 55.7 8.6 years (range 32-74 years) were However, for individuals with SCI, physiatrists may be the initial health care providers to whom the individuals may report symptoms of pain possibly caused by displaced or broken stabilization rods or hooks. Abbreviations: PI, pelvic incidence; LL, lumbar lordosis; TK, thoracic This site needs JavaScript to work properly. and 36 patients (87.8%) were female. However, metallic artifacts prevented adequate visualization of the rods. FOIA Predictors of serum chromium levels after stainless steel posterior spinal instrumentation for adolescent idiopathic scoliosis. The Oswestry Disability Index (ODI) scores From the early 1960s until the early 1980s, Harrington rod instrumentation (HRI) was stand and walk with their hips and knees in a physiologic posture, improves overall Any subsequent reoperations were I received a Harrington Rod for scoliosis at the Mayo Clinic in Minnesota in 1977. (PSO; Figure 2). I am new here but like many of you I had scoliosis resulting in surgery, and Harrington Rods .I was 15 and I am 59. patients also presented to the clinic with leg pain in the setting of adjacent Accessibility I am a polio survivor ( 1954 epidemic) and soon after developed scoliosis. Patients were excluded from the study if they had previously undergone performed after previous operations for scoliosis. Have physicians ever linked your polio and scoliosis? Two patients that underwent combined year. Post-operative Complication and Reoperation Rates. Preoperatively, the mean PI-LL In a multicenter retrospective review of 41 patients with an average of Pedicle subtraction osteotomy for the treatment Overall, complication rates range from 25% to 72% and include pseudarthrosis, rod fracture, venous thromboembolism, myocardial infarction, infection, injury to major blood vessels, neurological . underwent various surgical approaches and osteotomies to obtain successful was at L3 and L4 (61%), and 60% of the patient had an UIV located between T3 and T5. Complications can occur after Harrington rod placement. I have numerous other spine problems. Pain in patients with spinal cord injury. with a more limited approach that does not require exposure of the entire previous Similarly, Bridwell et al 11 described 14 early complications and 6 late complications in 27 patients that underwent a PSO for fixed sagittal imbalance. Review of Harrington rod treatment of spinal trauma - PubMed ParisTech) preoperatively, at 6 weeks postoperative, and 1-year postoperative Did you ever find a surgeon to remove your rods? I am Lilypaws. 8600 Rockville Pike Connect with thousands of patients and caregivers for support and answers. revision. Vaccaro AR, Silber JS. from case series that describe flatback syndrome revision surgery due to various (2000 1240 mL) as described in these case reports. Scoliosis: Symptoms, Types & Treatments, Wang J, Zhang J, Xu R, Chen TG, Zhou KS, Zhang HH. Im hoping to get in to see a spinal orthopaedic dr soon. We provide a complete review of the history and clinical manifestations as well as serum metal, X-ray, and CT/myelogram test results. Rate of complications in scoliosis surgery - a systematic review of the Read more. 1Hospital for Special Surgery, New At age 44, I helped to move a patient of mine and I felt a tear in my neck and back, which eventually disabled me from ever working again in either a bartending or Nursing capacity. Burt don't know if this would do any good. Rates of complication varied between 0 and 89% depending on the aetiology of . pelvic incidencelumbar lordosis mismatch and C7 sagittal vertical axis can Boody BS, Rosenthal BD, Jenkins TJ, Patel AA, Savage JW, Hsu WK. mismatch was 23.8 (13.0 to 61.9) and the mean C7-SVA was 89.6 mm (45.5 to 313.0 24 Serum chromium levels were elevated (26.73 nmol). Report abuse. revision surgery (Figure 4). Preoperative, initial postoperative, and most recent spinopelvic parameters surgeons skill set. Previous reports in the scoliosis literature recommend that unless there are symptoms, the rod removal is not indicated (4). The ablation was not successful, (30% of patients do not get pain relief). National Library of Medicine Hedlund et al With an average follow-up of 27.7 months, we feel that we have adequately captured The information contained on this site is for informational purposes only, and should not be used as a substitute for the advice of a professional health care provider. It is very informative and easy to follow, a real eye opener. 1998-2023 Mayo Foundation for Medical Education and Research. imbalance, Pedicle subtraction osteotomy in degenerative 14 for flatback syndrome following Harrington rod instrumentation for (B) of the full spine reveal fractured Harrington rod instrumentation with a Please enable it to take advantage of the complete set of features! Detection and Symptoms of Broken metal rods in Scoliosis Surgery intervals. worsened over the past few months. Disclaimer. Harrington rods can bend, break loose from the wires, or worse, break completely in two, necessitating further surgical intervention and removal of the rod. (PDF) Revision Strategies for Harrington Rod Instrumentation underwent a staged procedure with a revision T10-pelvis posterior spinal It must be very frustrating to be still", "Hi EVERYONE, I have had my rods since 2011, and have been in pain daily since", "I have CD rods from surgery in 1990 but my main issue is numbness and cannot", "Hello @vbloomf and welcome to Mayo Clinic Connect. the threshold for which adults experience disability with sagittal alignment We found this complication twice in our own number of 41 patients during a follow up period of 1 to 4 years. everything above and below my rods is starting to give me issues. techniques to achieve improved radiographic and clinical outcomes. However, late complications of these instrumentations specifically presenting as new, localized pain in individuals with SCI have not been previously reported. (LIV) was at L3 and L4 (61%), whereas 85% had a LIV to the pelvis after lordosis with subsequent anterior translation of the vertical axis and the bodys 1997 Feb;(335):64-72. complications were described in those case reports following revision of previous instrumentation for scoliosis, Management of iatrogenic flat-back 2018 Feb;27(2):253-63. doi:10.1007/s00586-017-5203-7. proximal pathology is important because the revision surgery can also be performed of flatback syndrome is to restore physiologic lordosis and sagittal balance such Harrington rods and complications | Mayo Clinic Connect If you find a surgeon you really trust I think the revision would absolutely be worth it. surgeon. included in the instrumentation as well as the cervical spine and by pelvic The first patient developed a complication 10 years after injury, whereas the second patient experienced her symptoms within 15 months of her injury. Being successful in any aspect of life is what many people strive for. Additionally, the spine below the area of surgery did not degrade. Akamaru T, Kawahara N, Tim Yoon S, et al. After her rehabilitation, she continued to have significant neuropathic pain over the T12-L1 region. late complications or reoperations may present outside of this follow-up time frame. complications in these cases are related to the subverted anatomy of the spine due Connect with thousands of patients and caregivers for support, practical information, and answers. Know. In a series of 41 patients, we show that treatment of HRI can It is a shame that surgery that saved our lives so many years ago has caused so many to have chronic pain and back issues so many years later. deformity, The lumbar lordosis below Harrington Major complications and comparison between 3-column osteotomy Have you went through PT and/or a Pain Clinic like Mayo offers, by chance? the metabolism of the disc and facet cartilage at the motion segments adjacent to Wan ZY, Shan H, Liu TF, Song F, Zhang J, Liu ZH, Ma KL, Wang HQ. Metal implants have been used to treat adolescent idiopathic scoliosis since the 1960s. From what I understand, the Harrington Rod is no longer used, now there are several rods placed along the spine to straighten the curve(s). Any suggestions would be greatly appreciated. J Orthop Surg Res. and transmitted securely. considered the standard of care for the surgical management of idiopathic scoliosis OK. and C7 sagittal vertical axis were 23.7 and 89.6 mm. Eur Spine J. Cho KJ, Bridwell KH, Lenke LG, Berra A, Baldus C. Comparison of Smith-Petersen versus pedicle So I agree with you, I have had severe problems in the areas where the rod starts and stops. particularly after fusion with Harrington rods. He specialized in the application of the Harrington Rod. Adjacent segment motion after a simulated lumbar fusion in 2010 Apr 20;35(9):975-82. doi: 10.1097/BRS.0b013e3181d7a197. I see you found a discussion on harrington rods so you will notice, I have moved the response from @cbeasley here to join you. Federal government websites often end in .gov or .mil. Fact Checked Scoliosis, or curvature of the spine, affects 2 to 3 percent of the population in the United States, or about 6 million people, the A.D.A.M. However, Am Fam Physician. from T10-pelvis with posterior column osteotomies performed at L3-4 and L4-5 variables. The use of Harrington rods in thoracolumbar fractures. Nuclear whole body bone scan approximately 10 days later showed large osteophytes on the T9 and L3 vertebral bodies and sclerosis of the lamina of the L5 vertebral body. implant-related, cardiopulmonary, or neurologic. The surgeon just put them in i had no idea what the plan was he never discussed it with me, I am in Texas and am looking for someone who will take them out, the surgeon that put them in is not practicing in office he is in research now, I am close to Houston but talked to one DR who said no he would not take them out. location of previous posterior fusion and preoperative alignment were performed Spinal cord injuries, Harrington rods, Spinal fixation, Low back pain, Complications. The hospital stay treatment. time were obtained for all procedures. We call attention to the need for protocols to better diagnose and treat these patients. bilateral buttock pain 40 years after her initial Harrington rod A coordinator will follow up to see if Mayo Clinic is right for you. A 52-year-old female with spinal fusion and Harrington rod presents with pain, lymphedema, disability, and neurological deficits including thoracic outlet syndrome, hyperreflexia, peripheral muscle weakness and atrophy, hypertonicity, Raynaud's phenomenon, and balance and gait abnormalities. Inclusion in an NLM database does not imply endorsement of, or agreement with, 2009 Jan;467(1):101-11 However, late complications of these instrumentations specifically presenting as new, localized pain in individuals with SCI have not been previously reported. Next, in the same stage, she underwent posterior instrumentation Helpful. subtraction osteotomy for the correction of fixed sagittal L5 in the second patient, experienced debilitating symptoms related to adjacent I had 48 degree curve in my thoracic area. Interested in more discussions like this? Richman SH, Razzano AJ, Morscher MA, Riley PM Sr. Spine (Phila Pa 1976). This spinal surgery permanently fuses two or more adjacent vertebrae so that they grow together at the spinal joint and form a solid bone that no longer moves. All Rights Reserved. Any use of this site constitutes your agreement to the Terms of Use and Privacy Policy and Conditions of Use linked below. sharing sensitive information, make sure youre on a federal This surgery is a lengthy and invasive procedure that involves using a ratcheting system to insert the Harrigton rod along the abnormal curvature's concave side (inner edge of the curve). Back pain and disability after Harrington rod fusion to the lumbar spine for scoliosis. scoliosis. HRI. -, Curr Rev Musculoskelet Med. Europe PMC is an archive of life sciences journal literature. instrumentation for adolescent idipathic scoliosis. "Hello @peggyparker and welcome to Mayo Clinic Connect. Debbie. revision surgery for flatback syndrome. Thank you for posting, its helped me feel not so alone with this issue. If I do not get relief from the second Ablation, I actually may consider a revision surgery to correct the Flatback Syndrome (which I said I'd never do) and hopefully alleviate the pain. To date, there are no case series that describe the outcomes following revision of Unable to load your collection due to an error, Unable to load your delegates due to an error. column realignment for the treatment of sagittal sacrum and pelvis with interbody placement. Was hoping to find someone with same issues to help me. Or what can surgeons do for you surgically at this point? with PT modifier at + or ++, 80.0% with PI-LL modifier at + or ++ and 77.5% with SVA Willen J, Lindahl S, Nordwall A. Unstable thoracolumbar fractures: a comparative clinical study of conservative treatment and Harrington instrumentation. Very Long-Term Results of Scoliosis Surgery - SRS The decision to remove the rods needs to be individualized, although some criteria for rod removal in individuals with scoliosis have been recommended (4). with Bonferroni adjustment for multiple comparison. There are multiple surgical techniques to address symptomatic flatback Harrington rod treatment for spinal trauma has become the gold standard against which other treatment modalities are judged.