MRI with Harrington rods?

[snowflake]

I had spinal fusion for severe, double-curve scoliosis in 1972 and have a long Harrington rod. I must have had a wonderful surgeon (Dr. Hugo Keim at Columbia Presbyterian in NYC), because I was pain-free and problem-free for almost 30 years. I've had two babies with no spine-related problems during pregnancy and normal deliveries. In recent years, my back has become "noisy," especially when carrying heavy items or twisting. The noises sound like bone crunching bone, and there is some sensation of grinding - but no pain - along with that. I began to have low back pain if I was on my feet too long or sitting bent over textbooks for too long. A recent new development of pain in the lower right quadrant sent me to the doctor suspecting an ovarian cyst, but an ultrasound exam found no problem in that area. My family doctor sent me for an x-ray to see if a problem in my lumbar spine might be the source of the pain. I don't have the radiologist's report yet, but I do have the x-ray, and even to my untrained eye, it doesn't look good. The Harrington rod appears to be attached at L3. Below this level, the vertebrae appear compressed and misaligned. I'm wondering if I can have an MRI with the metal rod in place. A woman who answered the phone at a local radiology facility says I can have an "open" MRI. If anyone has information or experiences to share, I would really appreciate hearing from you. :)

[babette71]

i too had concerns about having an mri with a harrington rod. i have been researching this and have been assured it is ok. many have. i am in nov.
i too had severe double curve and long fusion with harr. rod. i have lasted 24 years and had 3 children. i just saw a revision surgeon yesterday named dr. lenke. you are probably right about your vertabra below your fusion being worn out and off line. that is exactly my situation. you may also have flatback. you have been very blessed to have lasted this long many have needed revision surgeries much sooner.
i hope this was a help. my best to you.
barb

[snowflake]

I just got a copy of the radiologist's report on my lumbar spine x-ray. Among other things, it says "There is levoscoliosis identified." I'll have to look that one up. It also mentions "some questionable lucency seen surrounding the inferior laminar hook." Additionally, "There is some posterolateral fusion noted with some marked degenerative changes mostly at L3-4 and L4-5 with 5mm of anterolisthesis [?] of L4 on L5... with accentuation of the normal lordosis." There is disc space narrowing at L3-4. Osteopenia is identified as well. On the plus side, "There is preservation of vertebral body height." (Thank God for small favors...?) I'm guessing that the comment about anterolisthesis means that L4 is misaligned by 5mm with respect to L5 and is sort of "overhanging" it. I could see that myself on the x-ray. The radiologist recommends CT, MRI, or myelogram to better evaluate the situation. My family doc is referring me to an orthopedic.

Looks like I'm on my way. Does anyone know of a good (or great) revision doc in the Tampa area? :confused:

[Pips]

Can't help with your doc, sorry but I can tell you that it is fine to have an MRI with rods in place as I had one done just a few weeks ago. There were no problems at all from my end but the radiologist did say that they didn't always get the best pictures because of it.

Good luck!

[rainbow2010]

I have a steel rod from 1975 and I had an MRI. There is enough bone growth to hold your rod in place. Your back will get hot from the MRI and I had some pain, but I am sensitive to vibrations. The steel rod will cause distortion in the area around it. CT scans work better if you need the rod area checked.

[Shelgrl66]

I have NEVER heard of having an MRI with Harrington rods. I heard that you cannot with any metals, hence why they make you remove your jewelry, underwire bras, belt, etc. I don't know why anyone would want to risk it and it shocks me that someone would actually do an MRI with your Harrington rods, UNLESS you are having an MRI of the brain or other part that is not related to the spine. In all the years of myself having rods, and I've been dealing with my problems/instrumentations for 28 yrs, NOONE would let you do an MRI like that, nor did the doctor that was ordering the tests. That's not a risk I would take. There are CT scans and mylegrams (if you are able to because of the fusion). I had a lumbar mylegram through my fusion and rods at one time, but it took a LONG time to get the needle through, unless you go through the neck.

[BackTalk]

I have had numerous MRI's over the years with rods from top to bottom. There has never been a question about doing it and has never been problem. Trust your doctor and don't worry about the war stories you may hear. They wouldn't give you an MRI if it was going to hurt you.

[Shelgrl66]

Backtalk,
Actually it had nothing to do with my doctor(s) wanting an MRI...they didn't let me have one, NOR would they do one at the radiologists office. Trust me, I'm far from nervous on ANYTHING, but obviously the doctors knew what they were talking about, and the radiologists office. In that case then it you wouldn't have to take off ANY metals. Even metals fillings are an issue for them, as it can be pulled out. I've had enough problems where I doubt I would press the issue to do otherwise. There are other options besides an MRI.

[BackTalk]

Backtalk,
Actually it had nothing to do with my doctor(s) wanting an MRI...they didn't let me have one, NOR would they do one at the radiologists office. Trust me, I'm far from nervous on ANYTHING, but obviously the doctors knew what they were talking about, and the radiologists office. In that case then it you wouldn't have to take off ANY metals. Even metals fillings are an issue for them, as it can be pulled out. I've had enough problems where I doubt I would press the issue to do otherwise. There are other options besides an MRI.Too say the least I am confused with your situation. I have enough metal in me to start a junk yard, ckick here to see. http://i40.photobucket.com/albums/e232/jlazyh/DSCF1278-1.jpg I have just broken a rod and I am set for another MRI Tuesday morning. I will let you know if I made it, or have my wife let you know if I didn't.

[Susie*Bee]

Just thought I'd weigh in on this too... my doctor said there would be no problems with having MRIs in the future. I think there's just distortion caused by the hardware. Something else that the doctors don't all agree on, I guess.

Am adding this thought-- maybe it has to do with the difference in the old hardware (true Harrington rods) as opposed to what they use now. My surgery was just last year. I have stainless steel, but again, my surgeon said there would be no problem with having MRIs in the future. :confused: And yes, I understand there would be distortion/haloing around the hardware... Of course, I'm hoping there will be no need for having an MRI ever again! ;)

[Jenlw]

I was under the same impression as Susie*Bee. My doctor said that an MRI would be hard to read with all of the metal in my back, but I don't know if the Harrington Rod is different.

[JulieBW]

I had a lumbar MRI last year. No problems with heat or distortions. No one seemed concerned about my rod.

[Shelgrl66]

I guess every place is different, but every place I've ever been will NOT do an MRI over spinal hardware. They will do an MRI of the brain, but not over the hardware. This is just not something they do around here. They don't want to risk it because they have had incidences of metal implants being affected and pulled out and/or moved around during previous scans. They will not let you wear earrings, necklaces, belts and make your pull your pants down if you have metal buttons. Again, I guess every place is different. Every doctor I've ever had would not order an MRI of the spine because of my different hardware over the years. Me personally, I wouldn't want to risk it so-to-speak, especially when I'm already having enough problems. Why would I want more on top of it? Just my two cents.

[debbei]

Is this MRI question an issue for only Stainless Steel, or also for Titanium?

[rainbow2010]

titanium is not supposed to cause a problem. The debate about steel is because they use a giant magnet for the MRI and steel is attracted to the magnet. I saw my MRI and when they came to my steel rod, the films went wavy in that area. I'm sure as technology improves, they will develop a way for people with steel rods to have clear results with MRIs. In the mean time, CT scans work best in the area around steel rods.

[Qikdraw]

CT scans work best in the area around steel rods.

Really? I have two stainless steel luque rods and when they did a CT scan on me in the late 90's it came back unreadable. Too many artifacts created by the rods. Have things changed with the technology?

They are currently wanting to do a CT myelogram on me, and I am resisting big time. My last myelogram, before my surgery, had me in the hospital for a week. I don't want to go through that for a CT scan that will not work.

Any advice on this one?

Brad

[txmarinemom]

I just got a copy of the radiologist's report on my lumbar spine x-ray. Among other things, it says "There is levoscoliosis identified." I'll have to look that one up. It also mentions "some questionable lucency seen surrounding the inferior laminar hook." Additionally, "There is some posterolateral fusion noted with some marked degenerative changes mostly at L3-4 and L4-5 with 5mm of anterolisthesis [?] of L4 on L5... with accentuation of the normal lordosis." There is disc space narrowing at L3-4. Osteopenia is identified as well.

Just incase you haven't had this translated into lay terms yet ...

Levoscoliosis = a curve to the left (dextroscoliosis = to the right)

"Questionable lucency" means the area could be more solid (dense), or less solid, than expected (based on how much light it let through during the x-ray). I'd guess in a case where they're describing the area around an attachment hook for your rod, it means it's not as solid as they expect it to be.

"5mm of anterolisthesis" indicates the position of L4 is shifted forward and over L5 (an abnormal overlap)

"osteopenia" is a decrease is bone mineral density (usually shown as BMD on reports ... I just read my Mom's a few days ago) that is low enough to be abnormal, but not low enough to be considered osteoporotic (i.e., osteoporosis). BMD that indicates osteopenia does put you at a greater risk for osteoporosis, but it isn't an absolute. Bone mass reaches a peak at about age 30, and one of the best ways to build (and maintain) bone mass is via weight bearing exercises.

Some genetic factors make a person more prone to osteopenia (White and Asian females, especially those with a familial history, for example, are more at risk). Some outside influences (smoking, eating/metabolic disorders, excessive alcohol intake - among others) have also shown to increase risk. Post-menopausal women are more at risk for all forms of lowered BMD.

There are medications that may help stave off osteporosis (Actonel and Fossamax, among others) you may want to discuss with your doctor.

Now, as far as MRI's, the only downside to stainless steel (Harrington rods or newer hardware) and magnetic resonance imaging is an unclear view due to distortion. There is not a danger, and the magnets will not "rip out (or dislodge) the rods" as I've seen people say in various posts (not just in this thread).

One of the major advantages to both titanium and Vitallium hardware is "MRI-ability", i.e. clarity of the results.

Yes, some people *are* more sensitive to vibration (along with discomfort - and in rare cases, pain) with 316/316L SS hardware, but many claim to notice no sensation at all during an MRI. Open MRI's do exert less magnetic pull, but they also don't provide the clarity of a closed MRI. This is not to say the result of an open MRI may not be clear *enough* ... just that there is a difference.

Hope this helps :).

Best regards,
Pam

[Shelgrl66]

I was diagnosed with Osteoporosis in my late 20's because of the surgeries. I was on 10,000 iu of prescription dose Vitamin D and it helped get my hips back to normal (rather bring the BMD up). Now that I'm in my 40's, I guess it's time to have it checked out once again.

As for having MRI's with rods in your spine, I guess next time when they tell me to take off my jewelry, belt, underwire bra, etc I'm going to refuse. I don't understand then why I could never have an MRI because of my hardware, other than an MRI of the brain and still had to remove anything with metal in it. I will never get that. I guess every place is different.

1981-Harrington/Luque instrumentation T9-L5 for 30 degree thoracolumbar curve. Dr. Shufflebarger
1990-Revision surgery-Broken hardware/flatback deformity/pseudoarthrosis-Cotrel Dubousett instrumentation with extension into sacrum. (never done correctly) Dr. Shufflebarger
1995-Revision surgery-Severe flatback deformity/kyphosis-Moss Miami instrumentation (T5-sacrum) with titanium cages (back/front/back procedure), thoracoplasty, total reconstruction with osteotomies. (surgeon did surgery while coming down with chicken pox and developed encephalitis with brain damage, etc during 14 hr surgery) Dr. Shufflebarger
2005-Car accident-spinal cord injury/myelopathy from top of rods/hooks at T5. Surgery to remove hardware, with exception of cages. Permanent damage. Dr. Campbell
2008-5th surgery pending for severe stenosis in cervical spine, as well as lumbar spine because of prior surgeries.

[debbei]

I I don't understand then why I could never have an MRI because of my hardware, other than an MRI of the brain and still had to remove anything with metal in it.

From what I understand, it's because the hardware in your spine is 'anchored' into your bone. The doctor told me that if you have other metals in your body, say a metal wire that is connected to a pacemaker, it is so thin and small it could be ripped lose. I just had an MRI a few weeks ago, and even tho I don't have any hardware yet, I confirmed with him and the radiology center, that after my surgury, I will be able to have MRI's and they will be readable. They will just have to give me the injection of the contrast stuff so that they can see what they need it. They said it is perfectly safe to have MRI's afterwards.

Now....I'm wondering, what if you have a loose screw or a broken rod?? Hmmm...I'll have to ask about that.

[txmarinemom]

Shelgrl,

The reason they have you remove metal/jewelry is because you risk *distortion* of the results. There's really no point in lying there for a 45 minutes series (for each area) just to be stubborn and screw up the results unnecessarily.

If you elect to refuse to remove things like jewelry, that's your choice - and a huge waste of your money if the MRI is skewed.

That wouldn't be *my* choice, but that's just me.

Regards,
Pam

[Shelgrl66]

Hence why they don't usually do MRI's with hardware here either and why they don't do MRI's on my spine because of the hardware. It's all metal.

Shelgrl,

The reason they have you remove metal/jewelry is because you risk *distortion* of the results. There's really no point in lying there for a 45 minutes series (for each area) just to be stubborn and screw up the results unnecessarily.

If you elect to refuse to remove things like jewelry, that's your choice - and a huge waste of your money if the MRI is skewed.

That wouldn't be *my* choice, but that's just me.

Regards,
Pam

[debbei]

Hence why they don't usually do MRI's with hardware here either and why they don't do MRI's on my spine because of the hardware. It's all metal.

But my doctor and the radiology center said that they can do and get good images if they use the contrast stuff.

[rainbow2010]

When they do my CT scans, they tilt the machine about 30 to 45 degrees to get a better scan. They sometimes do 2 or 3 passes from different angles until they get a good scan. I have metal shavings near the base of my spine from where they cut off the bottom hook from my steel rod.

[green m&m]

I don't know about harrington rods since they are 'old surgical metals' but newer materials being use are non-ferrous so they won't go flying to attach to the magnet or distort the images as much as ferrous materials. If all metals were attracted to the the MRI magnets I'd have had locker keys and my glasses flying across the room... or some kid would have their face plastered to the MRI borrow because of their orthodontic braces

lots of people get scanned with 'metal' in their bodies. I've seen scans with joint replacement hardwares in place which are bigger chunks of metal than spinal instrumentation can be. Certain metal hardware are meant to become anchored and part of the body spine hard ware included. People with pace makers or aneurysm clips won't be allowed even near a MRI since the magnet is always on, and a clip moving would be potentially lethal...and pacemaker's signal getting disturbed isn't good.

Some place are just too lazy or don't have the right scan protocol that counters the artifacts to do scans on people with metal in them. Things have to be done differently than doing a standard spine protocol if someone has rods vs. a rodless spine.

I've only seen one or two places out of 7(?) places I've had scans done at that specifically asked if one had harrington rods. So there maybe some places that won't scan people with harrington rods but will scan those with more recent rods.

I've had my entire body scanned and there have been more artifacts from minor movement (like..eyelids/breathing) than my mouth full of cavity fillings.

[briarrose]

I just wanted to say that I had an MRI done at 6 days post-op to check for an infection and to make sure all the hardware was still in place (I passed out and fell on day 5). I have a titanium alloy rod and a commercially pure titanium rod. I don't know what the screws are. There was some distortion about the alloy rod due to some magnetic metals being present. There are three common metals that are magnetic (cobalt, nickel and iron) with nickel and cobalt being much less magnetic than iron. All of that to say that you can still have an MRI done with a small amount of magnetic material in your hardware.

[suemc]

Hi there,
I'm new to this site,but old with scoliosis and Harrington rod.
I had my surgery in 1977 at Hosp for Special Surgery in NYC by Dr.David Levine. I too had 2 children,no problems until after 2nd baby, then severe
lower back spasms which sent me to a local orthopedist who referred me to Dr.Levine. My rod fused 10 vertebrae to L3 or 4. Surgery was definitely a success for close to 18yrs. Problems began again and are worse, so I'm investigating revison surgery now at age 61.
To answer your MRI question, yes you can have one. I did. The
results were poor due to the rod being there. My neurologist looked at the CD and couldn't see much and the Dr. I'm seeing at New England Baptist in Boston says X-rays are mush more useful as did the Dr I saw inNYC at HSS.
Good Luck.
Suemc

P.S. Original curve: 85 upper, 72 lower. Surgical improvement to: 58 upper, 42 lower.
Today's curve: 80 upper, 70 lower.