Current status of the magnetically controlled growing rod in treatment of early-onset scoliosis: What we know after a decade of experience (original) (raw)
Related papers
Advances in Clinical and Experimental Medicine
Background. Non-invasive distractions of recently introduced magnetically controlled growing rods (MGCRs) spare multiple operations in the surgical treatment of early onset scoliosis (EOS). Since the costs of the implants are high, concerns have been raised regarding cost-effective, optimal but safe MGCR options: single or dual constructs. Objectives. To report deformity control, spinal growth and complication incidence in EOS patients treated with MCGR single-or dual-rod constructs. Material and methods. The study involved 47 patients with MCGRs inserted at Great Ormond Street Hospital, London (UK) in 2013-2014, who were followed up for at least 1 year. In 32 patients, T1-S1 distances, and coronal and sagittal curves were measured on preoperative and postoperative X-rays, and at a one-year follow-up. All complications were recorded. The patients were analyzed in 2 groups: those with single-rod constructs (24 patients) and those with dual-rod constructs (23 patients). Results. Comparing postoperative with one-year follow-up measurements, T1-S1 length increase was better in the dual-rod group (3.29%) than in the single-rod group (0.34%) (p = 0.031). In the whole series, mean scoliosis magnitude dropped by 27.5% at the one-year follow-up. The dual-rod group showed better mean curve correction: 36.5% compared to 15.3% in the single-rod group (p = 0.0076). Overall, 34.04% of the patients had complications: 45.8% in the single-rod group and 30.4% in the dual-rod group (p = 0.0413). Metalwork failure was observed in 8 patients, lengthening problems in 5 and wound infections in 2; there was also 1 case of proximal junctional kyphosis (PJK). Preoperative hyperkyphosis was associated with more complications (75%, p = 0.037), most of which were metalwork failure (41.6%). Conclusions. The MCGRs are efficient at controlling EOS; however, the complication rate is high, particularly in single-rod constructs. The use of dual-rod constructs allows for better curve control, greater T1-S1 length increase and a lower complication rate.
Journal of Pediatric Orthopaedics, 2016
Background: Traditional growing rods have a reported wound and implant complication rate as high as 58%. It is unclear whether the use of magnetically controlled growing rods (MCGR) will affect this rate. This study was performed to characterize surgical complications following MCGR in early onset scoliosis. Methods: A multicenter retrospective review of MCGR cases was performed. Inclusion criteria were: (1) diagnosis of early onset scoliosis of any etiology; (2) 10 years and younger at time of index surgery; (3) preoperative major curve size >30 degrees; (4) preoperative thoracic spine height <22 cm. Complications were categorized as wound related and instrumentation related. Complications were also classified as early (< 6 mo from index surgery) versus late (> 6 mo). Distraction technique and interval of distraction was surgeon preference without standardization across sites. Results: Fifty-four MCGR patients met inclusion criteria. There were 30 primary and 24 conversion procedures. Mean age at initial surgery was 7.3 years (range, 2.4 to 11 y), and mean duration of follow-up 19.4 months. Twenty-one (38.8%) of 54 patients had at least 1 complication. Fifteen (27.8%) had at least 1 revision surgery. Six (11.1%) had broken rods (2 to 4.5 and 4 to 5.5 mm rods); two 5.5 mm rods failed early (4 mo) and 4 late (mean = 14.5 mo). Six (11.1%) patients experienced 1 episode of lack or loss of lengthening, of which 4 patients subsequently lengthened. Seven patients (13.0%) had either proximal or distal fixation-related complication at average of 8.4 months. Two patients (3.7%) had infections requiring incision and drainage; 1 early (2 wk) with wound drainage and 1 late (8 mo). The late case required removal of one of the dual rods. Conclusions: This study shows that compared with traditional growing rods, MCGR has a lower infection rate (3.7% vs. 11.1%). MCGR does not appear to prevent common implantrelated complications such as rod or foundation failure. The long-term implication remains to be determined. Level of Evidence: Level IV.
Asian Spine Journal, 2019
Magnetically controlled growing rods have been used to treat early-onset scoliosis for the last 9 years; however, few studies have been published, with only short-term follow-up. The aim of the present study is to systematically review the outcomes of magnetically controlled growing rods in the treatment of early-onset scoliosis with a minimum of 2-year follow-up. Studies were included if patients with early-onset scoliosis (scoliosis diagnosed before 10 years of age) underwent implantation of magnetically controlled growing rods with a minimum of 2-year follow-up. The literature review and data extraction followed the established preferred reporting items for systematic review and meta-analysis guidelines. Data of distraction frequency, number of distractions, distracted length, Cobb angle, kyphosis, T1-T12 length, and T1-S1 length preoperatively, postoperatively, and at final follow-up were collected. Data regarding complications and unplanned reoperations were also extracted. The mean values of these parameters were calculated, or pooled meta-analysis was performed if available. Ten articles were included in this systematic review, with a total of 116 patients and a follow-up period between 23 and 61 months. The mean preoperative Cobb angle and kyphosis angle were 60.1° and 38.0°, respectively, and improved to 35.4° and 26.1° postoperatively. At final follow-up, the Cobb and kyphosis angles were maintained at 36.9° and 36.0°, respectively. The average preoperative T1-T12 and T1-S1 lengths were 180.6 mm and 293.6 mm, respectively, and increased to 198.3 mm and 320.3 mm postoperatively. T1-T12 and T1-S1 lengths were 212.3 mm and 339.3 mm at final follow-up, respectively. The overall rate of patients with complications was 48% (95% confidence interval [CI], 0.38-0.58) and unplanned reoperation 44% (95% CI, 0.33-0.55) after sensitivity analysis. The current evidence from different countries with a minimum of a 2-year follow-up suggests that magnetically controlled growing rods are an effective technique to treat pediatric scoliosis and promote spine growth. However, nearly half of patients still developed complications or required unplanned reoperations.
Guided Growth with Magnetic Rods in Early Onset Scoliosis . Preliminary Report
2020
Introduction: Early onset scoliosis (EOS) treatment with the magnetically controlled growing rod (MCGR) system allows for the use of non-invasive outpatient distractions. The purpose of this study was to assess our first series of EOS patients treated with MCGRs. Materials and methods: We conducted a review of EOS cases treated with MCGRs between 2014 and 2018. The study population was divided into two groups: Group I, patients undergoing primary MCGR insertion; Group II, patients undergoing conversion from conventional growth system to MCGR. Results: The study population consisted of 19 patients. The average age at the time of surgery was 7 years and 4 months, with an average post-operative follow-up of 2 years and 7 months. Group I consisted of 12 patients and Group II of 7 patients. The mean preoperative scoliosis angle was 62° and immediate postoperatively was 42°. The mean preoperative kyphosis angle was 49°and immediate postoperatively was 34°. The average preoperative T1-T12 ...
Magnetically controlled growing rods in the management of early onset scoliosis: a systematic review
Journal of Orthopaedic Surgery and Research
Background Early onset scoliosis (EOS) presents in patients younger than 10 years. Magnetically controlled growing rods (MCGR) were developed as an outpatient distraction system for EOS, allowing to avoid multiple surgeries. This systematic review investigated the efficacy and feasibility of MCGR in EOS. Methods This systematic review was conducted according to the PRISMA guidelines. PubMed, Google scholar, Embase, and Scopus were accessed in May 2022. All the clinical trials which investigate the role of MCGR for early onset scoliosis were accessed. Only studies reporting data in patients younger than 10 years with a preoperative Cobb Angle greater than 40° were eligible. The following data was extracted at baseline and at last follow-up: mean kyphosis angle, overall mean Cobb angle, mean T1–S1 length. Data from complication were also collected. Results Data from 23 clinical studies (504 patients) were included in the present study. 56% (282 of 504) were females. The average length...
Preliminary Results of Treatment of Early Onset Scoliosis using Magnetic Growing Rods
Global Spine Journal, 2016
Purpose: Reporting preliminary results of MCGR. Study design: A prospective uncontrolled, single-center, single-surgeon, clinical and radiological study Patient sample: Between November 2012 and March 2015, 14 children with EOS were treated using MCGR Outcome measures: Preoperative, postoperative and final follow-up (FFU) whole spine radiographs were reviewed to determine the degree of spinal deformity and correction, measured using Cobb angle. T1-S1 length was calculated. Clinical notes to determine number of rod lengthening procedures using remote control device and to record any complications during surgery or FU period. Methods: Mean age was 12.1 years, 2 boys and 12 girls, nine children had primary correction by MCGR; five of them had neuromuscular, three infantile and one congenital scoliosis. All had a dual MCGR implanted. The remaining five patients had previously undergone other growing rod operation before converting to MCGR implant. Results: Mean pre-operative Cobb angle of the primary group was 73.4°, postoperative 34.8° (51.3% correction), FFU 28.8°. Mean initial percentage of the lengthening was 18.4%. Thoracic kyphosis changed significantly from preoperative mean of 48.7° to 31.2° postoperatively (p=0.008). Of the revision group, mean pre-operative Cobb angle was 49.6°, postoperative 41.1° (16.5% correction) and 40.3° at FFU. Mean initial percentage lengthening was 6.9%. One patient had wound infection, two had pull-out of proximal screws, one sustained a breakage of a single-rod construct 6 months after surgery and was replaced by a double magnetic-rod construct. Conclusions: In our consecutive series of patients treated with MCGR we found that scoliosis was well controlled. Cobb angle was significantly reduced following surgery in patients who had MCGR performed as a primary procedure. Generally, the correction was maintained at FFU. Comparing our results for MCGR and other growing rod techniques, they are comparable, without need to repeated surgery.
Archives of Orthopaedic and Trauma Surgery, 2020
Introduction Magnetically controlled growing rods (MCGR) for the surgical treatment of early onset scoliosis (EOS) allow non-invasive outpatient based distractions during spinal growth. The purpose of this study is to present the results of a single center case series of 22 patients, evaluate the effect of MCGR treatment on the development of spino-pelvic parameters during growth, and report initial outcomes after end of treatment. Materials and methods Prospectively collected data of 22 EOS patients with MCGR treatment has been analyzed. The following radiological parameters were measured before index surgery, after index surgery, 1 year after index surgery, and at last follow-up: Cobb angle of the major curves, thoracic kyphosis (TK), lumbar lordosis (LL), sagittal vertical axis (SVA), pelvic incidence (PI), pelvic tilt (PT), and sacral slope (SS). Mean age at index surgery was 9.5 years (range: 4-14 years). Mean length of follow-up was 47.6 months (range: 25-121 months). Etiology of diagnosis was idiopathic in 14 patients, associated with neurofibromatosis in 2 patients, and neuromuscular or syndromic in 6 patients. Results Mean Cobb angle of the major curve was 57° preoperatively and 29° at last follow-up (p < 0.0005). Mean TK was 20.1° preoperatively and 20° at last follow-up (p > 0.05). Mean LL was 52.8° preoperatively and 53.2° at last follow-up (p > 0.05). Mean PI was 43.2° preoperatively and 46.3° at last follow-up (p > 0.05). Mean PT was 4.1° preoperatively and 5.8° at last follow-up (p > 0.05). Mean SS was 39.2° preoperatively and 41.7° at last follow-up (p > 0.05). 14 patients finished treatment: nine received final fusion and five received rod removal without fusion. Twelve complications occurred: one deep wound infection, six patients developed proximal junctional kyphosis (PJK), one rod fracture, two rods failed to distract, one deformity progressed after rod removal and required spinal fusion, and one patient developed autofusion of the spine prior to end of treatment. Conclusion MCGR treatment is able to control deformity progression. Complication rate was 54.5%. Sagittal balance was not altered and treatment does not seem to have a negative impact on the development of spino-pelvic parameters during growth. Optimal end of treatment for the individual patient still has to be defined.
Spine, 2017
Study Design. A retrospective review of prospectively collected clinical and radiologic data of patients with magnetically controlled growing rods (MCGRs) from a multi-centered study with a minimum of 2-year follow-up. Objective. The aim of this study was to describe the incidence and causes of unplanned reoperations and to report the outcomes of patients treated with MCGR for early-onset scoliosis (EOS). Summary of Background Data. Published clinical studies have demonstrated that MCGR is safe and effective for curvature control of EOS, and can avoid repeated surgeries for distractions. However, there have been no reports on the unplanned reoperations and complications of MCGR for EOS with a large series of patients. Methods. Between 2009 and 2012, 30 patients with EOS underwent MCGR implantation in six institutions. A retrospective review of prospectively collected clinical and radiologic data with a minimum of 2-year follow-up was conducted. Demographic data, radiologic measurements, unplanned reoperations, and other complications were noted. Risk factors for unplanned reoperations were analyzed. Results. Patients underwent MCGR implantation at the mean age of 7.2 years. The mean follow-up period was 37 months. Fourteen patients (46.7%) underwent an unplanned reoperation within the follow-up period, with a mean time to reoperation of 23 months after initial surgery (range, 5-48 months). Causes of unplanned reoperation were failure of rod distractions, proximal foundation failure, rod breakage, and infection. More frequent distractions (between 1 week and 2 months) were associated with a higher rate of reoperation than distraction frequencies between 3 and 6 months (71% vs. 25%). Conclusion. This is the largest series with the longest follow-up to date that examines the need for additional unplanned surgery after the initial procedure. It highlights that MCGR surgery can be associated with unplanned reoperations, and more frequent distractions may be a risk factor. Long-term comparative studies with traditional growing rod are required to evaluate the effectiveness of this implant.
Magnetically controlled growing rods in the treatment of early onset scoliosis
Bone & Joint Open
Aims Magnetically controlled growing rods (MCGR) have been gaining popularity in the management of early-onset scoliosis (EOS) over the past decade. We present our experience with the first 44 MCGR consecutive cases treated at our institution. Methods This is a retrospective review of consecutive cases of MCGR performed in our institution between 2012 and 2018. This cohort consisted of 44 children (25 females and 19 males), with a mean age of 7.9 years (3.7 to 13.6). There were 41 primary cases and three revisions from other rod systems. The majority (38 children) had dual rods. The group represents a mixed aetiology including idiopathic (20), neuromuscular (13), syndromic (9), and congenital (2). The mean follow-up was 4.1 years, with a minimum of two years. Nine children graduated to definitive fusion. We evaluated radiological parameters of deformity correction (Cobb angle), and spinal growth (T1-T12 and T1-S1 heights), as well as complications during the course of treatment. Res...