Chronic Bilateral Harrington Rod Fractures and Detrimental Sequelae in a Complete T12 Spinal Cord Injury: A Case Report

Case Diagnosis: 59-year-old male with a T12 AIS A spinal cord injury (SCI) secondary to motor vehicle accident in 1983 status post T8-L2 fusion with bilateral Harrington rods.

Case Description or Program Description: The patient presented as a referral from his primary care physician for low back pain and newly discovered bilateral Harrington rod fractures at T10-11 on prior X-ray and CT. He had been unable to lay on his back nor pressure relief for 10 years. Thus he developed a left non-healing gluteal wound for the past 6 years. Exam was notable for significant T8-11 tenderness bilateral to his prior surgical site with supine positioning intolerance.

Setting: Outpatient Rehabilitation Clinic

Assessment/Results: Repeat CT spine confirmed outside imaging and showed evidence of degenerative discs, myositis ossificans, and osteophytes from T9-L2. There was also spondylolisthesis and severe central canal stenosis from L3-S1. CT abdomen and pelvis showed soft tissue changes from the left ischium towards medial thigh, suspicious for wound tunneling. Rehabilitation was deferred for urgent referrals to Colorectal Surgery for wound exploration and Neurosurgery for hardware removal and replacement. Wound exploration ruled out anorectal fistula, though required extensive wound care and perianal nerve block. A light wheelchair with cushion system was provided to allow for pressure relief and improved mobility.

Discussion (relevance): Though Harrington rod implantation was largely discontinued by the late 1980s, late-effect complications from failure may still arise in patients with old spine fusions. Our case highlights the intractable pain, pressure wounds, adjacent segment disease, and myositis ossificans that can cascade without close, longitudinal monitoring by rehabilitation or primary care team. Because the patient had a complete SCI, the symptom severity was likely magnified given the lack of motor and sensory function below the level of injury.

Conclusions: Complete SCI patients with Harrington rod fusion require close monitoring to mitigate detrimental sequelae cascade from chronic hardware failure.