unbroken rod removal

[sweetness514]

I would get these ones you have removed if they are broken but then have new ones put in, you never know if the fusion could fail later on and the curves could come back. Just a thought.

[rainie]

unbroken rod removal

Hi, well I am one of the oldies that was operated on in 1966. I have been fused from T4 to L3 and have Harrington rods in my back. The only reason they are still there is I honestly didnt know I could have revision surgery.
I live In Tasmania which is an island off the coast of Australia and no one bothered to tell me. After the op it was life as usual. They didnt even tell me to come back in say 5 years for a check up, but I should have known to do that myself and am kicking myself for taking things for granted now.

For the past 8 years I have been suffering terrible and I mean terrible pain. There seems to be no known origin except being the flat lordosis down the bottom of my spine, slight degeneration of the discs around L4/L5. I know there is something wrong around the shoulder blade area as the pain there sort of grabs me, but all the Xrays I have had, the MRIs the lot of course do not show up anything in that area as the steel makes the Xrays be distorted.
All I know is i have a really high pain level tolerance and this pain is the worse I have ever had and I include having children in that, at least there is an end to that eh!!

Honestly if a doctor had said to me 10 or 20 years ago we will do this and that to help you in later life to make things easier for you, I really would hae jumped at the chance.
Now, I have no quality of life at all. I know I am having a bit of a sob story here, but I just want any of you to really listen to what your doctor recommends.
If only I had known all about revision surgery and rod removal I would have definatley had it done.
I have been told that I can have the rest of the lumbar part of my spine fused but I will be really stiff and it will be very uncomfortable and they could not even guarantee me then I would be pain free, so I said no.

A broken rod to me appears to be dangerous and I know I would have it out without even hesitating.

All the best to you all
Lorraine.

[cammaltby]

Hi Debo and all,

I had my revision almost 10 months ago with Dr Rand in Boston. I had a HR installed in 1972 and had developed the usual disc heriations and sagital imbalance accompanied by a great deal of pain.

Dr Rand chooses to leave an intact HR in place, when possible. He says that he recognizes that theoretically new hardware hanging off the old could stress the old rod and cause a breakage...but so far that has not happened. He did relate some harrowing incidents of trying to dig out old imbedded HR's and I suspect concluded that leaving "well enough alone" might be the way to go in many cases. For me, he exposed the botton two inches of the old rod, cut it off with bolt cutters (according to the surgical report) and attached the new hardware to the old. So far, so good.

The added benefit of this approach is that the incision and all the "work" on the posterior is fairly low and none of the musclature of the upper back is disturbed. I didn't really understand the benefit he was describing until about a week after surgery when I realized that on top of everything else, I was not dealing with the inabilty to lift my arms!

Anyway, I suspect there is variation in approach and reasons why or why not to remove old rods. Dr Rand says he is in the process of developing a device that will actually may it easier to attach in place hardware to the new stuff..so there may be a bit of an evolution going on here.

If you want to see a picture of this old/new config check out:

http://health.groups.yahoo.com/group/Flatback_Revised/

then go to photos and see the one that says "Cam's new spine"

you may have to join to get in that far...

At 10 months post I have little pain, and as I am beginning to do PT and stretch a little, I hope that what compomises I make because I can no longer bend at the waist are small compared to what I can do now painfree. I don't know what kind of choices are available in Tasmania...but I do think there is some reason to hope that you can find a different solution than that much pain for the rest of your life.

~Cam
Good luck with your decision

[LindaRacine]

Some recent research on this subject:

Spine. 2006 Jan 1;31(1):67-72. Related Articles, Links

Loss of coronal correction following instrumentation removal in adolescent idiopathic scoliosis.

Potter BK, Kirk KL, Shah SA, Kuklo TR.

Department of Orthopaedics and Rehabilitation, Walter Reed Army Medical Center, Washington, DC 20307, USA.

STUDY DESIGN: Retrospective radiographic analysis of patients with adolescent idiopathic scoliosis (AIS) status after instrumentation removal. OBJECTIVE: To evaluate the effect of instrumentation removal in surgically corrected AIS. SUMMARY OF BACKGROUND DATA: Spinal instrumentation is occasionally removed for various reasons, most commonly for postoperative pain or infection, in surgically corrected AIS. The fate of instrumentation removal in adults has been previously reported with documented loss of sagittal alignment. However, to our knowledge, the long-term follow-up after instrumentation removal in AIS has not been reported. METHODS: We retrospectively reviewed the preoperative, pre-instrumentation removal, postoperative following instrumentation removal, and latest follow-up radiographs of all patients with a primary diagnosis of AIS who underwent instrumentation removal after posterior spinal fusion. There were 21 patients (15 females, 6 males) from 2 institutions, at an average age of 14.8 years (range 9-19), who were originally treated between 1988 and 2002. Instrumentation removal occurred at an average of 2.4 years after surgery (range 8 months to 4 years, 2 months), with an average follow-up of 5.2 years (range 2-11). Fifteen patients underwent removal secondary to pain (2 of these with undetected infection) and 6 for known infection. Evaluation included coronal proximal thoracic, main thoracic, thoracolumbar/lumbar (TL/L), and sagittal T2-T5, T5-T12, T2-T12, T10-L2, T12-S1, and sagittal balance before surgery, before instrumentation removal, at immediate post-removal evaluation, and at latest follow-up. RESULTS: There were 12 main thoracic curves (Lenke type 1), 6 double thoracic curves (Lenke type 2), and 3 double major curves (Lenke type 3) in the series. Average proximal thoracic curve was 19.7 degrees (range 5 degrees -35 degrees ), the main thoracic curve 63.3 (range 42 degrees -112 degrees ), and the TL-L curve averaged 31.4 degrees (range 17 degrees -53 degrees ). There was an immediate loss of approximately 4 degrees (range 0 degrees -8 degrees ) in the main thoracic curve and 6 degrees (range 1 degrees -15 degrees ) in the TL/L curve after removal, with continued settling of an additional 6 degrees (10 degrees total, P = 0.002) in the main thoracic curve, and 3 degrees in the TL/L curve (9 degrees total, P = 0.01). There was also a significant difference in the group that underwent instrumentation removal <2 years after surgery compared to >2 years (main thoracic curve 13 degrees vs. 7 degrees , P = 0.017; TL/L 11 degrees vs. 7 degrees , P = 0.036). There were no significant changes in sagittal curvature or sagittal balance in either group (P > 0.39). CONCLUSIONS: Instrumentation removal in AIS is not always a benign process because the long-term follow-up of this cohort of patients shows a "settling" effect in the coronal plane of the main thoracic and TL/L curves after instrumentation removal. Interestingly, there was no change in the sagittal plane with time. Parents and patients should be counseled for this result when instrumentation removal is contemplated, and limited removal of focally symptomatic implants should be considered.