Surgery is often hailed as the be-all and end-all cure for scoliosis. And the Harrington rod is used in the majority of scoliosis surgeries performed in the U.S. It’s been used on idiopathic scoliosis patients since the 1960s, and, though the surgical techniques and equipment have evolved, the gist of the surgery remains the same.
How the Harrington Rod Works
Scoliosis spinal fusion surgery is performed by inserting a Harrington rod with a ratcheting system along the concave part of the curve and attaching it to the spine with two hooks (one at the top of the curve and the other at the bottom). The surgeon then uses the ratcheting system to stretch and straighten the spine before fusing it (often replacing the spinal discs with bone grafts from the patient’s hip) into that straightened position.
Due to the nature and purpose of a spinal fusion, that portion of the spine will not be able to bend as it did before. The spinal discs are removed and the vertebra in the curve are all fused together to straighten the curve. Spinal fusions can take weeks to take hold and fully form. The Harrington rod is able to support the spine while it’s fusing and provides ongoing support in later years.
The procedure is available (and recommended by most surgeons) for anyone with a Cobb angle higher than 45 degrees. However, it’s generally considered unwise to operate on children still growing. Growing spines have a much higher risk of the scoliosis substantially increasing above and below the fused areas once the surgery is completed (this is called the ‘Crankshaft’ phenomenon). Plus, it’s possible to outgrow the rod if the surgery is performed before you’re finished growing. In that case, you’d need to have another surgery to remove and replace the rod, which is no easy feat.
Complications and Risks
By its very nature, the surgery to implant a Harrington rod into the spine is incredibly intrusive. To make room for the rod and to prepare for the fusion, the surgeon removes the spinal discs, and the nearby muscles and soft tissue take a beating. The ratcheting system is screwed into your vertebras and pulled to forcefully bend your spine in the opposite direction and then fuse it in that position.
In any major surgery, you’re at risk for severe blood loss, urinary infections from catheterization, pancreatitis and obstructive bowel dysfunction from immobilization after surgery. Aside from those, the list of possible complications for scoliosis surgery includes:
- Bending or breaking of the Harrington rod
- Fusion not taking (called ‘pseudoarthrosis’)
- Curve increasing in later months/years despite the surgery
- Flatback (a painful condition where the cervical, thoracic and/or lumbar spine lose their curve after the thoracic curve is straightened)
- Neurological complications such as partial or total paraplegia, quadriplegia or a peripheral nerve deficit (which often manifests as an abnormal or loss of sensation in your legs)
- Additional surgeries to fix complications or failures due to a trauma (like a car accident or bad fall)
This is an image of an actual Harrington rod that was removed from a patient’s spine after it broke, just six months after the surgery. You can see the break in the middle of the rod on the left.
There’s no coming back from this surgery. You can remove the Harrington rod, but you can’t un-fuse a fused spine. And this surgery will permanently affect the way you move on a daily basis. Many patients are surprised to find out how much their mobility has decreased after the surgery. Studies have shown that the overall mobility decreases by 25 percent after the surgery. And with the loss of mobility in one section of the spine, more pressure is placed on the other sections. This can cause increased pain, discomfort and an increase in those affected curves.
The absence of spinal discs could also end up being a drawback. Without spinal discs, any major jolt could cause an accelerated amount of pain and damage to your spine. Spinal discs exist to soften those blows, so an incident like a minor car crash would be much more agonizing for someone with a spinal fusion.
Not a Cure
The Harrington rod does straighten the Cobb angle in most cases, however, it can’t be considered a cure because it fails to address the underlying causes of scoliosis. It takes a curved spine and replaces it with an unnaturally straight and inflexible one.
Because those underlying causes weren’t addressed with the surgery, it can’t prevent the spine from curving down the road. Many patients experience an increased Cobb angle five to ten years down the road, despite the Harrington rod and the spinal fusion. It also doesn’t always put a stop to the symptoms that many scoliosis patients experience. Any pain you’re experiencing will likely not disappear after the surgery.
Benefits of Alternative Treatments
There is a time and a place for scoliosis surgery. For extremely severe cases, where the Cobb angle is over 80 degrees, surgery could be the only way to remove the pressure it puts on the organs. But in most cases, the surgery isn’t a medical emergency. And as such, it’s best to treat it as a last resort. Alternative treatments like physical therapy and scoliosis-specific chiropractic adjustments have been shown to correct the curve without surgery as well as address quality of life symptoms like pain, trouble sleeping and headaches.
In fact, many patients see improved success rates and fewer complications with the Harrington rod surgery after they first test out the other treatment options available. Tension in the spinal cord can prevent the spine from bending into a fully straight position, limiting the success of the surgery. Stretches and exercises can work to create a more flexible spinal cord ahead of the surgery. A flexible spinal cord also reduces the risk of neurological complications during the surgery.
In the end, whether or not you move forward with the Harrington rod surgery is entirely your call. Talk through all of your options with your doctor, keeping in mind that there is no rush to make this decision. Trying other treatment options first won’t negatively affect the results of the surgery. They may even improve those results!
Are you thinking about the Harrington rod surgery? Have you already had the surgery? What benefits or drawbacks have you found? Share your story with us in the comments below.