Spine Curving After Harrington Rod Removal

[Megan]

Hello,

I had spinal fusion surgery when I was 16 (I'm not sure exactly what vertebrae were fused, but my scar is around 12 in.) After keeping the Harrington rods in my back from over two years, I decided to take them out since some pieces of the hardware were protruding. I thought this would be great because it would eliminate the possibility of infections and further complications caused by hardware. Several weeks after the removal surgery, my spine started curving again. My surgeon was very surprised. He has been talking about a 3rd surgery to put the hardware back in, but I would really like to avoid that. I have searched for answers or for someone else who has had this same complication, but have not found anyone. I have thought about using a chiropractor, but I don't know if they could help me since my spine is fused and curving.

Any thoughts or advice would be so greatly appreciated!!

Megan

[Pooka1]

Hi. Welcome and sorry to hear about recent developments.

Linda (the moderator) or Toni (a patient with training) hopefully will chime in here about loss of correction after rod removal.

I can add that is not the paradigm at all which is that once fusion has occurred (presumably by the two years you had your instrumentation in), you can remove the rods with no or minimal loss of correction. I have seen a paper where some small correction losses in the transverse plane were noted over several years (see figure in http://en.wikipedia.org/wiki/Sagittal_plane) which I suppose would be a rotation about a vertical axis.

When was your surgery? Do you have Harrington rods or the newer generation instrumentation? Maybe fusion wasn't so certain with H rods as it is with the newer stuff. I have no idea.

How much correction did you lose? Where is the curve?

Good luck.

[Pooka1]

By the way, while there might be some evidence that chiro, like any massage, can help with pain, there is no evidence it can halt curvature. Chiros have no relevant training in scoliosis. The only people with the appropriate training are board certified orthopedic surgeons.

Here's why chiros shouldn't be treating anyone for anything in my opinion...

http://www.scoliosis.org/forum/showthread.php?t=11146

Good luck.

[Megan]

Hi. Welcome and sorry to hear about recent developments.

Linda (the moderator) or Toni (a patient with training) hopefully will chime in here about loss of correction after rod removal.

I can add that is not the paradigm at all which is that once fusion has occurred (presumably by the two years you had your instrumentation in), you can remove the rods with no or minimal loss of correction. I have seen a paper where some small correction losses in the transverse plane were noted over several years (see figure in http://en.wikipedia.org/wiki/Sagittal_plane) which I suppose would be a rotation about a vertical axis.

When was your surgery? Do you have Harrington rods or the newer generation instrumentation? Maybe fusion wasn't so certain with H rods as it is with the newer stuff. I have no idea.

How much correction did you lose? Where is the curve?

Good luck.

Thank you for your reply. My revision surgery was August 2009. I did have the Harrignton rods and my doctor said part of the problem may be that the rods are so strong these days, the spine didn't have to build up it's own strength. I can't remember for sure what my curve had been while I had the rods in, but I think they had it somewhere in the 30s (had been 53 degrees before the fusion surgery.) It is now up to 51. My surgeon said they may only have to put the rods back in for the lumbar curve since the thoracic seems to be stable.
Thanks again for your thoughts!

[Pooka1]

So your original surgery was in 2007, yes?

I didn't realize anyone was still using H-rods in 2007 but what do I know?

Did you have screws and hooks by the way?

Again, I hope folks who know what they are talking about will respond but if you lost virtually all the correction after the rods were removed then it seems like you never fused even after two years. I can say I haven't read a testimonial like that before so it's good you posted.

So did you have a double major and they only fused the thoracic curve? Or did you have a lumbar curve with a compensatory thoracic curve? I'm just trying to figure that out from what you wrote.

What levels were originally included in your fusion?

[Megan]

So your original surgery was in 2007, yes?

I didn't realize anyone was still using H-rods in 2007 but what do I know?

Did you have screws and hooks by the way?

Again, I hope folks who know what they are talking about will respond but if you lost virtually all the correction after the rods were removed then it seems like you never fused even after two years. I can say I haven't read a testimonial like that before so it's good you posted.

So did you have a double major and they only fused the thoracic curve? Or did you have a lumbar curve with a compensatory thoracic curve? I'm just trying to figure that out from what you wrote.

What levels were originally included in your fusion?

Yes, the first surgery was in 2007. I was 16. There were the wonderful screws and hooks ....they were causing the most problems because some were protruding. I really don't know the terminology about the curves. I don't feel like I have been very informed by my dr. which I know is partly my fault. But from what I know, both curves were fused, I don't know for sure if one is a compensatory curve or not. After the removal surgery, my dr said I had a good fusion. I'm so confused and feel a little lost with this whole thing. I guess I thought I would have the first surgery in '07 and be done with it...but, that didn't happen.

[Pooka1]

Yes, the first surgery was in 2007. I was 16. There were the wonderful screws and hooks ....they were causing the most problems because some were protruding. I really don't know the terminology about the curves. I don't feel like I have been very informed by my dr. which I know is partly my fault. But from what I know, both curves were fused, I don't know for sure if one is a compensatory curve or not. After the removal surgery, my dr said I had a good fusion. I'm so confused and feel a little lost with this whole thing. I guess I thought I would have the first surgery in '07 and be done with it...but, that didn't happen.

Someone will dope-slap me if I'm wrong but...

... if you had screws and hooks, you do not have H-rods but rather a modern segmental construct.

... if you had both curves fused then you had a double major curve. Though there have been rare claims by patients who said their surgeon was going to fuse a non-structural curve, I think these people were most likely mistaken barring rare cases.

... if you lost all the correction within several weeks of hardware removal two years after being fused, I don't think you could have been fused at all. There was a recent testimonial where a young girl had to have her hardware removed after only several months and she lost correction but that was nowhere close to the two years you had your hardware.

If I were you, I would gather up all the reports and radiographs and get an opinion from a board-certified orthopedic surgeon experienced with scoliosis revisions. Here is a starting point to find someone...

http://www.srs.org/find/

Again, good luck.

Do you have pain?

[titaniumed]

Megan

I’m so sorry about this. Bone remodeling happens in 2 years. Apply a constant force, and bone will reshape itself.

Read Karen Ockers material. It happened to her. She had an early fusion in 1956 without hardware and she progressed and finally had her revision and new hardware installed.

[Karen Ocker]

In 1956 I had a fusion T4-L-3. A year not walking-in casts for the fusion to heal.--Necessary before hardware was used. Always told my fusion was "solid". By age 59 80 deg thoracic curve.
Revision age 60. See signature for details. This was 8 years ago and i am pain free.

[Pooka1]

Megan

I’m so sorry about this. Bone remodeling happens in 2 years. Apply a constant force, and bone will reshape itself.

Yes this is consistent with the paradigm that you can remove the hardware at this point and not lose the correction.

That's why it is completely mysterious as to why Megan lost all correction within several weeks and after two years of having the hardware. That is a unique testimonial as far as I can tell though I have only been reading here for a few years.

[tonibunny]

It's sometimes very difficult to tell whether a fusion really is solid or not. Certainly x-rays aren't always enough, and you'd need a nuclear bone scan at least to try to find if there are any areas of pseudarthrosis (non-fusion). Have you had any investigative work done Megan?

I've heard of other cases like Karen's where a solid, uninstrumented fusion has progressed but these cases have all been in very large post-op curves, much larger than 30ish degrees.

I'm also inclined to think that you have some other type of rod, as Harringtons don't have screws, just hooks at the ends. It's understandable if you think you have a Harrington though as some doctors use the name as a generic term for any spinal rod for scoliosis, even for the most modern hardware out there!

Some degree of "settling" is expected after surgery, and isn't usually seen as a problem. From 30s to 51 degrees is a lot though and personally I'd suspect that you have a pseudarthrosis that hasn't been identified.

[Pooka1]

It's sometimes very difficult to tell whether a fusion really is solid or not. Certainly x-rays aren't always enough, and you'd need a nuclear bone scan at least to try to find if there are any areas of pseudarthrosis (non-fusion).

I was told point blank you cannot see fusion on a radiograph. That said, I would want to investigate that claim much more to see if there are nuances.

As regards Megan's surgeon's comment, I assume that was a comment after seeing the spine during the hardware removal procedure. But then it is even more mysterious that a surgeon eyeballs the spine and says it fused, she has hardware for two years, and still she lost all correction within several weeks.

Something is very strange here. It has to be one or more points of pseudoarthrosis as you suggest. But then that becomes a touch scary as to why a young, healthy teenager would develop a pseudoarthrosis like that. I must say I am a touch scared for my kids.

Megan, were you given physical restrictions and did you follow them? You don't have to answer any question by the way.

[titaniumed]

Sharon

I agree.... Doesn’t happen often

It must have something to do with the imbalanced muscle forces.

Some live with relatively large “stable” curves for long periods of time, and some scolis are like wildfire.

Guess what? I need to run down to my mailbox as I finally found a copy of Moe’s original book “Textbook of scoliosis and other spinal deformities” on Amazon. Used, of course. This should be a neat read! 1978. He started SRS in 1966.

Ed

[hdugger]

Guess what? I need to run down to my mailbox as I finally found a copy of Moe’s original book “Textbook of scoliosis and other spinal deformities” on Amazon. Used, of course. This should be a neat read! 1978. He started SRS in 1966.

Wow, good find.

If you happen to notice anything in there about boys having worse outcomes or more serious progression, could you send up a flare? Someone mentioned once having read that in that text, but I've never seen that information anywhere else.

[LindaRacine]

Hi Megan...

It's unlikely that you had Harrington rods. If you had screws to attach the rods to your spine, they were definitely not Harrington rods.

In any case, your spine is probably more unstable now than it was before your original surgery. During the surgery some pieces of bone were likely removed to help with correction of the curves. Because of that, your spine can actually curve more than it would if you never had surgery.

With that said, if you don't have a lot of pain, or if the deformity doesn't bother you, there's no rush for surgery. You can wait and see what happens.

Good luck with your decision.

Regards,
Linda