Harrington Rod Revision Surgery in New York City

Dr. Zeeshan Sardar, MD, MSc, F.R.C.S.C
Director Quality & Patient Safety (QPS) – Och Spine Hospital
Medical Director, Spine Unit – Och Spine Hospital
Co-Chief of Spinal Deformity Surgery • NewYork-Presbyterian / Columbia University
Och Spine Hospital • New York, NY

If you had scoliosis surgery decades ago with a Harrington rod and are now experiencing back pain, difficulty standing upright, or new neurological symptoms, you are not alone. Thousands of patients who underwent Harrington rod instrumentation between the 1960s and 1990s are now living with late complications that were not fully understood at the time of their original surgery. These complications are real, they are progressive, and in many cases they are correctable.

Dr. Sardar has specialized expertise in the evaluation and surgical revision of patients with prior Harrington rod instrumentation. These are among the most technically demanding cases in all of spine surgery, and they represent a significant portion of his practice. Patients travel from across the country to see him specifically for this problem.

WHAT IS A HARRINGTON ROD?

The Harrington rod was the first widely used surgical implant for scoliosis correction. Developed by Dr. Paul Harrington in the 1950s and used extensively from the 1960s through the early 1990s, it consisted of a single metal rod attached to hooks at the top and bottom of the curved segment of the spine. The rod was used to distract (lengthen) the spine on the concave side of the curve, partially straightening it.

While Harrington rods were a major advance for their time and helped many patients, the instrumentation had significant limitations that were not fully appreciated until years later. Most critically, the Harrington rod corrected the scoliosis curve in the coronal plane (side-to-side) but did not maintain or restore the normal front-to-back curves of the spine — particularly the natural inward curve of the lower back (lumbar lordosis). Over time, this led to a condition now known as flatback deformity, one of the most debilitating late complications of Harrington rod surgery.

LATE COMPLICATIONS OF HARRINGTON ROD SURGERY

Flatback Deformity

Flatback deformity is the most common and most disabling late complication of Harrington rod instrumentation. It occurs when the normal lumbar lordosis — the inward curve of the lower back — is lost or reversed, causing the patient to lean progressively forward. Standing upright requires constant, exhausting muscular effort. Walking becomes painful and difficult. Many patients find themselves unable to stand for more than a few minutes at a time.

Flatback deformity typically worsens slowly over years or decades. Many patients notice it beginning in their 30s or 40s, well after their original surgery, and find that it steadily robs them of function and quality of life. The condition does not improve on its own and cannot be managed conservatively once it reaches a significant degree.

Hardware Failure

Harrington rod hardware — the rods, hooks, and any supplemental wiring used — can fail over time. Rods may fracture, hooks may dislodge, and fusion masses can crack (pseudarthrosis). Hardware failure may cause a sudden increase in pain, a change in posture, or new neurological symptoms. It is diagnosed on imaging and typically requires surgical revision to stabilize the spine.

Adjacent Segment Degeneration

A long spinal fusion places increased mechanical stress on the discs and joints immediately above and below the fused segment. Over decades, this accelerated wear can cause significant degeneration at adjacent levels — leading to disc herniation, stenosis, pain, and neurological symptoms that were not present at the time of the original surgery. In some patients, the fusion needs to be extended to address these adjacent level problems.

Pseudarthrosis

Pseudarthrosis means the fusion did not fully heal — a non-union has developed within the fused segment. This can cause persistent or worsening pain, deformity, and hardware stress fractures. It is identified on CT scan and typically requires revision surgery to achieve a solid fusion.

Crankshaft Phenomenon

In patients who had Harrington rod surgery before skeletal maturity, continued growth of the anterior (front) spinal column against a fused posterior (back) column can cause the spine to twist and worsen despite the fusion. This is called the crankshaft phenomenon and may require anterior surgical procedures to address.

Neurological Symptoms

New or worsening leg pain, numbness, weakness, or problems with bladder or bowel function in a patient with prior Harrington rod surgery warrant urgent evaluation. These symptoms can arise from adjacent segment stenosis, hardware migration, instability, or deformity progression causing nerve compression.

THE EVALUATION PROCESS

Every patient with prior Harrington rod instrumentation receives a comprehensive evaluation at their first visit with Dr. Sardar. This includes:

Detailed history — when the original surgery was performed, what was done, how symptoms have evolved over time
Full-length standing X-rays — 36-inch scoliosis films to assess overall spinal alignment, sagittal balance, and curve magnitude
CT scan — to evaluate fusion integrity, hardware status, and bone quality
MRI — to assess the discs, nerves, and spinal cord above, below, and within the fused segment
Sagittal balance analysis — quantifying the degree of forward imbalance and planning the correction needed to restore normal alignment

Dr. Sardar will explain exactly what your imaging shows, what it means for your symptoms, and what surgical and non-surgical options are available. He will never recommend surgery unless it is clearly the right path for your specific situation.

SURGICAL OPTIONS FOR HARRINGTON ROD REVISION

Revision surgery for Harrington rod complications is highly individualized. The procedure is designed around each patient’s specific anatomy, deformity pattern, bone quality, overall health, and goals. Common surgical components include:

Osteotomy for Flatback Correction

Restoring lumbar lordosis in a patient with flatback deformity requires cutting through the fused bone to create a controlled correction — a procedure called an osteotomy. The type of osteotomy used depends on the degree of correction needed:

Smith-Petersen Osteotomy (SPO) — a posterior wedge resection that achieves approximately 10–15 degrees of correction per level; multiple levels can be performed
Pedicle Subtraction Osteotomy (PSO) — a more powerful three-column osteotomy that achieves 30–40 degrees of correction at a single level; used when greater correction is needed
Vertebral Column Resection (VCR) — reserved for the most severe or rigid deformities; involves complete removal of one or more vertebral bodies and is among the most technically demanding procedures in all of spine surgery

Hardware Removal and Replacement

Old Harrington rod instrumentation is typically removed and replaced with modern segmental pedicle screw-rod constructs, which provide far superior three-dimensional control and allow for precise correction of sagittal alignment. Modern implants are engineered to maintain the correction long-term in a way that Harrington rods could not.

Extension of Fusion

Depending on the extent of adjacent segment degeneration or instability, the fusion may need to be extended above or below the original construct. The level of the pelvis (sacrum and ilium) is often included in revision constructs to achieve a solid foundation and optimal sagittal balance.

Bone Grafting and Biologics

Achieving a solid fusion in revision surgery requires robust bone grafting. Dr. Sardar uses a combination of local bone graft, iliac crest bone graft, and bone graft substitutes or biologics as appropriate for each patient’s situation and bone quality.

WHAT TO EXPECT: SURGERY & RECOVERY

Harrington rod revision surgery is major surgery. Recovery is more involved than a primary spine procedure, and patients should expect a meaningful recovery period. That said, the functional gains for appropriately selected patients can be dramatic — many describe being able to stand upright without pain for the first time in years.

Hospital stay: Typically 4–7 days depending on the extent of surgery.
Mobility: Most patients are walking with assistance the day after surgery.
Return to light activity: 6–12 weeks for most daily tasks.
Full recovery: 6–12 months for the fusion to mature and full functional gains to be realized.
Pre-operative optimization: Bone density, nutritional status, and medical comorbidities are carefully reviewed and optimized before surgery to maximize safety and outcomes.

Dr. Sardar coordinates closely with internal medicine, anesthesia, and other specialists as part of a multidisciplinary approach to ensure each patient is as prepared as possible before surgery. He personally follows every patient from the pre-operative visit through all post-operative appointments.

FREQUENTLY ASKED QUESTIONS

I had a Harrington rod placed 30 years ago and feel fine. Should I be worried?

Not necessarily. Many patients do well for decades. However, it is worth having a periodic evaluation with a spine specialist familiar with Harrington rod complications — particularly if you have noticed any change in posture, increasing difficulty standing upright, or new back or leg symptoms. Catching problems early generally means simpler treatment.

Can the Harrington rod be removed without doing other surgery?

In some cases, yes — particularly if the hardware is causing local symptoms such as prominence under the skin or local irritation. However, isolated hardware removal without addressing the underlying deformity or fusion status is rarely the complete answer for patients with flatback deformity or significant sagittal imbalance. The decision depends entirely on the individual’s imaging and symptoms.

How do I know if my symptoms are from the Harrington rod?

The hallmark symptoms of late Harrington rod complications — progressive forward lean, fatigue and pain with standing, difficulty looking straight ahead while walking — are fairly characteristic. However, some symptoms overlap with other spinal conditions. A thorough evaluation with appropriate imaging is the only way to know for certain. If you have prior Harrington rod instrumentation and new or worsening symptoms, a specialist evaluation is always appropriate.

I was told I’m too old or too high-risk for revision surgery. Should I get a second opinion?

Yes, if you feel your quality of life is significantly impacted and you have not had an evaluation at a high-volume deformity center. Age alone is rarely an absolute contraindication. Surgical risk depends on overall health, bone quality, and the extent of surgery required — not age in isolation. Many patients in their 60s and 70s have excellent outcomes after carefully planned revision surgery. A thorough pre-operative evaluation will give you and your surgeon the clearest picture of what is realistic for your situation.

WHY CHOOSE DR. SARDAR FOR HARRINGTON ROD REVISION

Harrington rod revision surgery requires a surgeon with deep experience in complex spinal deformity reconstruction, osteotomy techniques, and long-segment revision constructs. It is not a procedure that should be undertaken by a surgeon who performs it rarely.

Dr. Sardar completed his advanced spinal deformity fellowship at Columbia University and NewYork-Presbyterian, one of the highest-volume deformity programs in the country. His three fellowship training programs — spanning orthopedic and neurosurgical spine, disc replacement, and complex deformity — give him an unusually broad technical foundation for managing the full range of complications that can arise in revision surgery.

As Co-Chief of Spinal Deformity Surgery at the Och Spine Hospital at NewYork-Presbyterian, he leads one of the highest-volume adult spinal deformity programs in the country. A significant portion of his practice consists of revision cases referred by surgeons elsewhere who are not comfortable proceeding.

He uses robotic-assisted navigation, intraoperative neuromonitoring, and real-time 3D imaging as standard tools in all complex revision cases, maximizing both precision and safety.

Patients travel from across the United States and internationally to see Dr. Sardar for Harrington rod revision. Telemedicine consultations are available for patients in NY, NJ, CT, FL, PA, MO, CA, and TX. International patients can contact NewYork-Presbyterian Global Services at +1-212-746-9100.

This page is for educational purposes only and does not constitute individualized medical advice. Please consult a qualified spine specialist to discuss your specific condition and treatment options.