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Thread: unbroken rod removal

  1. #1
    Join Date
    Aug 2005
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    6

    Question unbroken rod removal

    I just found this website today and I'm impressed with the amount of information here! I have had a Harrington rod since Sept. 1976. Now at 43, I've had 3 disc surgeries as a result of degeneration caused by the rod. I have one last disc that is scheduled to be repaired soon. My doctor wants to remove the rod as a preventative measure when he does the disc surgery. It is not broken and is not causing me any pain. I have pain from the disc, but that damage is already done and removing the rod won't change it now. He says all Harrington rods bread eventually and that it needs to be replaced with new instrumentation before it does. I might not have questioned this, but my sister's rods broke this summer and the very same doctor does not plan to replace her rods unless she is losing correction or is in excrutiating pain (his words). She had her scoliois surgery last Sept., so her rods are different from mine, but I don't understand why the same doctor would leave broken rods in one patient and want to remove unbroken rods from another. Every doctor who has seen my x-rays, including this doctor, says my spine fused beautifully, so there's no problem there. Is it true that all Harrington rods break? Is there something more dangerous about them breaking than newer rods? I am thinking about refusing to let him remove it until and unless it breaks or causes problems. Does anyone have advice or information about this? I have an appointment in a few weeks and I want to go in with as much knowledge as possible.

  2. #2
    Join Date
    Jun 2005
    Posts
    62
    We do not know whether all Harrington rods will break, because spinal fusion with instrumentation was first performed with regularity only since the mid-1960's. Therefore the patients who were the first ones to receive Harrington rods have had them for approximately 45 years. It is difficult to predict whether these people will have spinal issues markedly different from the non-instrumented population as they all reach their 70's and 80's. It would be informative to hear from this group to find out how they are doing. I have had my Harrington rods for 38.5 years and I do not have any problems.
    Regarding degenerative disc disease, there are many variables involved. I understand that the location of your primary curve, as well as the number and location of the vertebrae fused could contribute to degenerative disc disease. Did your doctor explain to you exactly how your rods caused your discs to degenerate? In any case, good luck with your appointment.

  3. #3
    Join Date
    Feb 2005
    Location
    NC
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    My Harrington Rod is broken.. I had my surgery in 1977, and it broke only about 3 months ago. I have no pain at the break site, however I do have a lot of pain in my bottom 2 vertebra that aren't included in my initial fusion.

    The specialist I saw last month says the break in the rod is "no big deal", and that the fusion is solid at the site of the break.

    From what I've read/heard and experienced... degenerative disc and herniation is common in us 'old timers' with earlier surgeries/fusions.

    In my case, those 2 vertebra have 'carried the load' so to speak for so long, they are just plain worn out. So, now.. pain is a part of my life, and it seems that will just be the case until such time that glorified body is given to me!

  4. #4
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    Aug 2005
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    As in Cindy B's case, the discs below the rod have worn out from bearing the weight of my fused spine and rod. They are being repaired as needed. Now I only have one disc left below the rod that is not fused, and I am going to have that done relatively soon.

    To Cindy B: has your dr. considered surgery to repair your discs? I have been in a great deal of pain at times, but surgery has relieved it.

  5. #5
    Join Date
    Sep 2003
    Location
    Northern California
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    6,802
    Hi Debo...

    I'd like to encourage you to get a second opinion before agreeing to more surgery. No where near all Harrington rods are expected to break. People who have an area that doesn't fuse are the ones who have their rods break. A doctor that tells you that all rods will eventually break is potentially a REALLY bad surgeon.

    If you post where you live, someone can probably give you a recommendation for a second opinion.

    Regards,
    Linda

  6. #6
    Join Date
    Feb 2005
    Location
    NC
    Posts
    31
    debo,
    My doctor will do surgery... as a last resort. I really don't want surgery if I can avoid it, and that's what I'm trying to do.

    Linda.. Isn't it odd that where my rod broke, my fusion is solid? The break is high up.. right between the shoulder blades.

    Oh well.. No one ever accused me of being normal!

  7. #7
    Join Date
    Aug 2005
    Posts
    6
    Cindy B, I certainly understand wanting to avoid surgery. For me though, it's worth it to alleviate the pain. My sister lives with a lot of pain and I just wouldn't want to have to live like that. She can't do many things she enjoys and at 41, that's too young! I have a "let's fix it so I can have some fun!" attitude.

    I live in Amarillo, TX and my doctor is supposed to be one of the very best. I don't doubt that he is a wonderful surgeon, but I'm really confused now that I've read about all the people here with broken rods that are not routinely being replaced. I still wonder why on earth he would even contemplate removing a perfectly good rod?

    As I stated in my first post, my sister had surgery for her scoliosis last Sept., but I didn't mention that my 16 year old daughter had it last July as well. My sister's rods have broken and my daughter is having problems with the hooks and will probably have them removed next summer. I didn't enjoy staying in bed 2 months and wearing a body cast for 9 months when I had mine done almost 30 years ago, but it seems to me that the new technology might not be better in the long run. Are there more malfunctions in the newer instrumentation?

  8. #8
    Join Date
    Sep 2003
    Location
    Northern California
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    6,802
    Hi Cindy...

    There's no way to REALLY know if the spine is fused in any one area. I've been told that rods really only break if there's a non-fusion, or if there's too much stress (in which case they would break fairly soon after surgery).

    Regards,
    Linda

  9. #9
    Join Date
    Feb 2005
    Location
    NC
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    31
    Quote Originally Posted by LindaRacine
    Hi Cindy...

    There's no way to REALLY know if the spine is fused in any one area. I've been told that rods really only break if there's a non-fusion, or if there's too much stress (in which case they would break fairly soon after surgery).

    Regards,
    Linda
    Then, I am the exception. A non-fused scoliosis spine like mine, would continue to curve.. if it wasn't fused.

    What you may have been told.... isn't necessarily true in all cases..

    Since! My rod is broken.. and only happened a few months ago.. Been there since 1977.. AND, my fusion IN that area is solid.


    What I see.. is that since the Harrington Rod is a "ratchet" type rod.. It's at the point of the connection, or.. rather the ratchet that has come apart... broken. That's where my break is.


    debo..


    I understand you're wanting to be "able" at your age.. I am 43.. and am much more limited than I was only 2 years ago.


    I, too have a 16 year old daughter. No surgery for her, yet.

    It's the difference between night and day.. as far as how they treat scoliosis now.

    I also spent 9 months in the cast! Was that the pits, or what?

    If surgery is what you need to do.. then you go for it! We are all different, and our needs and treatments will be different. *hug*




  10. #10
    Join Date
    Aug 2005
    Posts
    6
    Cindy B,

    Yes, the cast was the pits! I'm glad people don't have to deal with that anymore, although it may have served a useful purpose.

    So, your daughter has scoliosis too? Both of my daughters have it, but my oldest. age 19, only has 16 degree curve and stopped growing 5 years ago with no progression, so she is not being treated at this time. I worry though, that she'll be like my sister and end up having surgery in her 40's. My youngest, 16, bounced right back from surgery, but it's harder when you're older. Do you have any other relatives with scoliosis? My cousins don't have it, but their daughters do. My sister has 4 boys and none of them have it, but it's my understanding that it's rare in boys.

  11. #11
    Join Date
    Jun 2005
    Posts
    62
    Although other instrumentation systems are curently in use, Harrington rods were designed to withstand significant stress. The initial specifications are described as follows: "The distraction rod is a prestressed instrument designed for a yield point over 400 pounds on axial loading and over 200 pounds on eccentric loading." Harrington, Paul R., M.D., "Scoliosis in the Growing Spine," Pediatric Clinics of North America, February, 1963, Vol. 10, No. 1, W.B. Saunders Company. At the time this article was written, approximately 400 instrumentation and fusion operations had been performed. Further design changes and refinements in surgical technique occurred after the publication of this article. Harrington rods were designed to withstand the stresses of day to day life, but not necessarily stresses resulting from events such as severe car accidents or contact sports.
    P.S. I received this article along with my post-operative instructions from Dr. Harrington in December, 1966.

  12. #12
    Join Date
    May 2005
    Posts
    19
    Quote Originally Posted by debo
    I still wonder why on earth he would even contemplate removing a perfectly good rod?
    Debo,

    I am not a mind reader nor am I a medical expert in the least, but I can't help wondering if there might be another reason your doctor wants to remove your instrumentation. I am having revision surgery in December due to DDD and lumbar stenosis and while my fusion is super solid and the H-rods themselves don't seem to be giving me any trouble, all or part of my old instrumentation will be removed and new instrumentation will be added.

    It is my understanding that there are a couple of reasons this will be done:

    1. Stability - Since some of the lamina wll be removed and all that is unfused is totally worn out, the new instrumentation will protect me from more serious damage. I am also told that the movement causes pain, so if you stabilize it, it shouldn't hurt so much.

    2. Sagittal balance - Since my lumbar spine was completely flattened when I had my original surgeries (I was 10 and 14 when the H-rods were "installed"), my doctor will be able to return some of the lordosis to my low back, which will make me "look" a little more normal as well as help my skeleton function more naturally, thus alleviating the degree of wear and tear I have experienced for the last 24 years.

    It might be a good idea to ask your doctor about additional reasons for removing your instrumentation as well as what kinds of problems he thinks might arise if it is left in (besides breaking).

    Hope this helps!

    I am going to Amarillo next week for a second opinion. Who is your doctor?

    kam
    Last edited by d_ann; 08-25-2005 at 05:10 PM.

  13. #13
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    Aug 2005
    Posts
    6
    Thanks, it did give me some possible reasons other that what he gave me. As far as stability, I've already had 2 of the discs below the rod fused about 5 years ago, and now I'm having problems with the 3rd (and last) disc. Dr. LaGrone, my doctor, is planning to fuse that one as soon as I am ready. I haven't asked him yet, but I wonder if the disc fusions provide stability? Until a few months ago, I was pain free and seemed to be in good shape. The dr. that did my other discs, Dr. Paullus, a nuero, told me the last disc would eventually wear out and need to be fused, and evidently, he was right, because here I am again. I am actually in very little pain. Right now I'm in the 'numb, tingling leg phase' but I know it will progress as time goes by.

    I am so lucky I don't have problems with sagittal balance. I don't have a flat back and don't care to have one either! If Dr. LaGrone replaced my rod, would he put in new ones to encompass those 3 discs below the old one? Is that what you mean by increasing stabilty? Could that cause flat back? I would rather just have the disc fused.

    I realize I need to ask him these questions, and I will, but it's nice to have input from others with similar problems. I would venture to guess that most people in this forum are quite knowledgable about all this.

    Right now, I am recovering from disc surgery in my neck, and my appointment next week is post-op for that. The last time I saw Dr. LaGrone, I tried to talk to him about my lower back, but he said we would wait until I heal from this first. He may put me off and not want to discuss it yet.

    Is he your dr.? He is reputed to be one of the best in the country and I trust his skill completely. I'm just questioning his motives and judgement in my case.

  14. #14
    Join Date
    May 2005
    Posts
    19

    Dr. LaGrone

    Actually, I am scheduled for surgery with Dr. Bridwell in St. Louis, but am going to Dr. LaGrone for a 2nd opinion. I don't think you will find anyone who will dispute Dr. LaGrone's opinion too heavily. My sagittal balance isn't bad, but I do not have any lordosis in my lumbar spine. Dr. B stated that he thinks he can achieve sufficient lordosis with the cages he'll put in the disc space.

    It is my understanding that when the rest of your spine is fused, it is "safer" to add instrumentation so that you don't develop a point of non-fusion or psuedoarthrosis. Someone can correct me if I am confused about this...

    How long is your original fusion? I am fused from T4 - L4 and will be fused to the sacrum after surgery. But, I am in a lot of pain and most everything is uncomfortable. The additional instrumentation (and there will be A LOT) makes me feel safer. I figure if I am already worn out, the reinforcement is a good idea. My mom was concerned about them adding even more stuff to my back and was relieved and concerned at the same time to hear they will be removing my old rods. I don't think we will know how people fare from these revision surgeries for quite some time, but I do know of people who have made it quite a few years and are doing quite well. I am sure that staying physically fit makes a big difference.

    Since you are local (in Amarillo), is there a hotel you would recommend close to Dr. L's office? We are driving in the day of my appt. and will spend the night. I know Amarillo pretty well, but have stayed with friends in the past and have never been to Dr. L's office.

    Thanks for whatever you can share!

  15. #15
    Join Date
    Oct 2005
    Posts
    1

    Harrington Rod Removal

    I am waiting to have my harrington rods removed from my back. I'd like to know if anyone who has had this done remembers how long it took to recover properly and if it was worthwhile?

    I have dwyer rods on my lower back and harrington on my upper back, not sure of the exact discs, they have been fused. I had the dwyers when I was 25 and harringtons when I was 27, I am now 31. I twisted my back 3 months ago while picking something up and heard a snap in my back and for at least a month I had a loud creaking sound when I moved, no pain. After an xray and MRI nothing was found to be wrong but it was suggested I have them removed in case there was metal shavings. There is no sound now and the only pain I get is my lower back, from sitting too long.

    Any help would be amazing thanks.
    Last edited by brandiesnap; 10-26-2005 at 03:09 AM.

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