The Harrington rod (or Harrington implant) is a

stainless steel Stainless steel is an alloy of iron that is resistant to rusting and corrosion. It contains at least 11% chromium and may contain elements such as carbon, other nonmetals and metals to obtain other desired properties. Stainless steel's corros ...

surgical device Surgery ''cheirourgikē'' (composed of χείρ, "hand", and ἔργον, "work"), via la, chirurgiae, meaning "hand work". is a medical specialty that uses operative manual and instrumental techniques on a person to investigate or treat a pat ...

. Historically, this rod was implanted along the

spinal column The vertebral column, also known as the backbone or spine, is part of the axial skeleton. The vertebral column is the defining characteristic of a vertebrate in which the notochord (a flexible rod of uniform composition) found in all chordates ...

to treat, among other conditions, a lateral or coronal-plane curvature of the spine, or

scoliosis Scoliosis is a condition in which a person's spine has a sideways curve. The curve is usually "S"- or "C"-shaped over three dimensions. In some, the degree of curve is stable, while in others, it increases over time. Mild scoliosis does not t ...

. Up to one million people had Harrington rods implanted for scoliosis between the early 1960s and the late 1990s.

History

The Harrington implant was developed in 1953 by Paul Harrington, a professor of

orthopedic surgery Orthopedic surgery or orthopedics ( alternatively spelt orthopaedics), is the branch of surgery concerned with conditions involving the musculoskeletal system. Orthopedic surgeons use both surgical and nonsurgical means to treat musculoskeletal ...

Baylor College of Medicine Baylor College of Medicine (BCM) is a medical school and research center in Houston, Texas, within the Texas Medical Center, the world's largest medical center. BCM is composed of four academic components: the School of Medicine, the Graduate Sc ...

Houston, Texas Houston (; ) is the most populous city in Texas, the most populous city in the Southern United States, the fourth-most populous city in the United States, and the sixth-most populous city in North America, with a population of 2,304,580 in ...

. Harrington rods were intended to provide a means to reduce the curvature and to provide more stability to a spinal fusion. Before the Harrington rod was invented, scoliosis patients had their spines fused without any instrumentation to support it; such fusions required many months in plaster casts, and large curvatures could progress despite fusion.

Purpose

Harrington rod instrumentation was used to treat instability and deformity of the spine. Instability occurs when the spine no longer maintains its normal shape during movement. Such instability results in nerve damage, spinal deformities, and disabling pain. Spinal deformities may be caused by

birth defects A birth defect, also known as a congenital disorder, is an abnormal condition that is present at birth regardless of its cause. Birth defects may result in disabilities that may be physical, intellectual, or developmental. The disabilities can ...

fractures Fracture is the separation of an object or material into two or more pieces under the action of stress. The fracture of a solid usually occurs due to the development of certain displacement discontinuity surfaces within the solid. If a displa ...

marfan syndrome Marfan syndrome (MFS) is a multi-systemic genetic disorder that affects the connective tissue. Those with the condition tend to be tall and thin, with long arms, legs, fingers, and toes. They also typically have exceptionally flexible joints a ...

neurofibromatosis Neurofibromatosis (NF) is a group of three conditions in which tumors grow in the nervous system. The three types are neurofibromatosis type I (NF1), neurofibromatosis type II Neurofibromatosis type II (also known as MISME syndrome – multi ...

neuromuscular disease A neuromuscular disease is any disease affecting the peripheral nervous system (PNS), the neuromuscular junction, or skeletal muscle, all of which are components of the motor unit. Damage to any of these structures can cause muscle atrophy and w ...

s, severe injuries, and

tumors A neoplasm () is a type of abnormal and excessive growth of tissue. The process that occurs to form or produce a neoplasm is called neoplasia. The growth of a neoplasm is uncoordinated with that of the normal surrounding tissue, and persists ...

. By far, the most common use for the Harrington rod was in the treatment of scoliosis, for which it was invented.

Description

The device itself was a stainless steel distraction rod fitted with hooks at both ends and a ratchet and was implanted through an extensive posterior spinal approach, the hooks being secured onto the

vertebral The vertebral column, also known as the backbone or spine, is part of the axial skeleton. The vertebral column is the defining characteristic of a vertebrate in which the notochord (a flexible rod of uniform composition) found in all chordates ...

laminae. It was used at the beginning without performing a

spinal fusion Spinal fusion, also called spondylodesis or spondylosyndesis, is a neurosurgical or orthopedic surgical technique that joins two or more vertebrae. This procedure can be performed at any level in the spine (cervical, thoracic, or lumbar) and pre ...

but early results proved fusion as part of the procedure was mandatory, as movement of the unfused spine would cause the metal to fatigue and eventually break. The procedure required the use of a postoperative plaster cast or bracing until vertebral fusion had occurred.

Flatback syndrome

Flatback syndrome is a problem that develops in some patients treated with Harrington rod instrumentation, where the rod extends down into lower part of the lumbar spine. Because the Harrington cannot follow the natural

lordosis Lordosis is historically defined as an ''abnormal'' inward curvature of the lumbar spine. However, the terms ''lordosis'' and ''lordotic'' are also used to refer to the normal inward curvature of the lumbar and cervical regions of the human spi ...

of the lower back (i.e. the backwaist curve), the spine is straightened out into an unnatural position. At first, the unfused spinal segments compensate for the straightening effects, but eventually the discs degenerate and wear down. The patient then develops back pain, has difficulty standing upright, and experiences limitations when walking. Eventually, the problem requires surgery to realign the spine. As exemplified by Pecina and Dapic in the European Spine Journal (February 2007), flatback syndrome is not inevitable and does not happen to every person with a low Harrington rod instrumented fusionthere are many people who have had Harrington rods for decades with no adverse effects.

References

{{Reflist

External links

Medscape – Modern Posterior Thoracic Instrumentation

20-year follow-up of Harrington instrumentation in the treatment of severe Idiopathic Scoliosis
Pecina & Dapic, ''European Spine Journal'' Vol 16 No 2 Feb 2007 (subscription only) Orthopedic implants Orthopedic surgical procedures