Guided Growth with Magnetic Rods in Early Onset Scoliosis. Preliminary Report
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Published:
Nov 18, 2020
Keywords:
Early onset scoliosis, magnetically controlled growing rods
Main Article Content
Abstract
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 of12 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 length was 160mm and immediate postoperatively was 176mm. The average preoperative T1-S1 length was 285mm and immediate postoperatively was 317mm. There was 1 late complication, an implant protrusion with an associated infection, in a neuropathic scoliosis patient (Group II) who required implant removal.
Conclusion: Our preliminary results suggest that the MCGR system is a safe and effective method. Although the short- and medium-term results are encouraging, further studies are warranted to overcome important and unknown challenges regarding the mechanical behavior of the implant in the long term.
Level of Evidence: IVKey words: Early onset scoliosis, magnetically controlled growing rods.
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 of12 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 length was 160mm and immediate postoperatively was 176mm. The average preoperative T1-S1 length was 285mm and immediate postoperatively was 317mm. There was 1 late complication, an implant protrusion with an associated infection, in a neuropathic scoliosis patient (Group II) who required implant removal.
Conclusion: Our preliminary results suggest that the MCGR system is a safe and effective method. Although the short- and medium-term results are encouraging, further studies are warranted to overcome important and unknown challenges regarding the mechanical behavior of the implant in the long term.
Level of Evidence: IVKey words: Early onset scoliosis, magnetically controlled growing rods.
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How to Cite
Orellana, C., Noel, M., Bersusky, E., Remondino, R., Galaretto, E., Tello, C., Piantoni, L., & Francheri Wilson, I. A. (2020). Guided Growth with Magnetic Rods in Early Onset Scoliosis. Preliminary Report. Revista De La Asociación Argentina De Ortopedia Y Traumatología, 85(4), 377-386. https://doi.org/10.15417/issn.1852-7434.2020.85.4.1060
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Clinical Research
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References
Bibliografía:
1. Skaggs DL, Guillaume T, El-Hawary R, Emans J, Mendelow M, Smith J. Early Onset Scoliosis Consensus
Statement, SRS Growing Spine Committee. Spine Deform 2015;3(2):107. https://doi.org/10.1016/j.jspd.2015.01.002
2. Williams BA, Matsumoto H, McCalla JD, Akbarnia BA, Blakemore LC, Betz RR, et al. Development and initial
validation of the classification of early onset scoliosis (C-EOS). J Bone Joint Surg Am 2014;96(16):1359-67.
https://doi.org/10.2106/JBJS.M.00253
3. Campbell RM Jr, Smith MD. Thoracic insufficiency syndrome and exotic scoliosis. J Bone Joint Surg Am
2007;89(Suppl):108-22. https://doi.org/10.2106/JBJS.F.00270
4. Pehrsson K, Larsson S, Nachemson A. Long-term follow-up of patients with untreated scoliosis. A study of mortality, causes of death, and symptoms. Spine 1992;17(9):1091-6. https://doi.org/10.1097/00007632-199209000-00014
5. Vitale MG, Matsumoto H, Roye DP Jr., Bye MR, Gomez JA, Booker WA, et al. Pulmonary function, radiographic
measures, and quality of life in children with congenital scoliosis: an evaluation of patient outcomes after early
spinal fusion. Spine (Phila Pa 1976) 2008;33(11):1242-9. https://doi.org/10.1097/BRS.0b013e3181714536
6. Sankar WN, Acevedo DC, Skaggs DL. Comparison of complications among growing spinal implants. Spine (Phila Pa 1976) 2010;35(23):2091-6. https://doi.org/10.1097/BRS.0b013e3181c6edd7
7. Cheung KM, Cheung JP, Samartzis D, Mak K, Wong Y, Akbarnia BA, et al. Magnetically controlled growing rods
for severe spinal curvature in young children: a prospective case series. Lancet 2012;379:1967-74.
https://doi.org/10.1016/S0140-6736(12)60112-3
8. Skov ST, Wijdicks SPJ, Bünger C, Castelein RM, Li H, Kruyt MC. Treatment of early-onset scoliosis with a hybrid
of a concave magnetic driver (magnetic controlled growth rod) and a contralateral passive sliding rod construct with apical control: preliminary report on 17 cases. Spine J 2018;18(1):122-9. https://doi.org/10.1016/j.spinee.2017.06.027
9. Beaven A, Gardner AC, Spilsbury JB, Marks DS, Mehta JS, Newton-Ede M. Magnetically controlled growing rods:
the experience of mechanical failure from a single center consecutive series of 28 children with a minimum follow-up of 2 years. Asian Spine J 2018;12(5):794-802. https://doi.org/10.31616/asj.2018.12.5.794
10. Dannawi Z, Altaf F, Noordeen H, Harshavardhana NS, El Sebaie H. Early results of a remotely-operated magnetic growth rod in early-onset scoliosis. Bone Joint J Br 2013;95(1):75-80.
https://doi.org/10.1302/0301-620X.95B1.29565
11. Akbarnia BA, Pawelek JB, Sponseller PD, Cheung KM, Demirkiran G, Hazem El Sebaie H. et al. Traditional
growing rods versus magnetically controlled growing rods for the surgical treatment of early-onset scoliosis: a casematched 2-year study. Spine Deform 2014;2(6):493-7. https://doi.org/10.1016/j.jspd.2014.09.050
12. Bekmez S, Dede O, Yazici M. Advances in growing rods treatment for early onset scoliosis. Curr Opin Pediatr
2017;29(1):87-93. https://doi.org/10.1097/MOP.0000000000000432
13. Bess S, Akbarnia BA, Skaggs DL, Thompson GH, Sponseller PD, Shah SA, et al. Complications of growingrod
treatment for early-onset scoliosis: analysis of one hundred and forty patients. J Bone Joint Surg Am
2010;92(15):2533-43. https://doi.org/10.2106/JBJS.I.01471
14. La Rosa G, Oggiano L, Ruzzini L. Magnetically controlled growing rods for the management of early-onset
scoliosis: a preliminary report. J Pediatr Orthop 2017;37(2):79-85. https://doi.org/10.1097/BPO.0000000000000597
15. Yilmaz G, Huri G, Demirkran G, Dalolu K, Ozkan C, Alanay A, et al. The effect of posterior distraction on
vertebral growth in immature pigs: an experimental simulation of growing rod technique. Spine (Phila Pa 1976)
2010;35(7):730-3. https://doi.org/10.1097/BRS.0b013e3181bcc3a3
16. Tello CA. Harrington instrumentation without arthrodesis and consecutive distraction program for young children with severe spinal deformities. Experience and technical details. Orthop Clin North Am 1994;25:333-51.
PMID: 8159406
17. Wu AM, Cheung JPY, Cheung KMC, Lin JL, Jin HM, Chen D, et al. Minimum 2-year experience with magnetically
controlled growing rods for the treatment of early-onset scoliosis: a systematic review. Asian Spine J 2019; 13(4):
682-93. https://doi.org/10.31616/asj.2018.0272
18. Bekmez S, Afandiyev A, Dede O, Karaismailolu E, Demirkiran HG, Yazici M. Is magnetically controlled growing
rod the game changer in early-onset scoliosis? A preliminary report. J Pediatr Orthop 2019;39(3):e195-e200.
https://doi.org/10.1097/bpo.0000000000001268
19. Rolton D, Richards J, Nnadi C. Magnetic controlled growth rods versus conventional growing rod systems in the treatment of early onset scoliosis: a cost comparison. Eur Spine J 2015;24:1457-61.
https://doi.org/10.1007/s00586-014-3699-7
20. Jenks M, Craig J, Higgins J, Willits I, Barata T, Wood H, et al. The MAGEC system for spinal lengthening in
children with scoliosis: a NICE Medical Technology Guidance. Appl Health Econ Health Policy 2014;12:587-99.
https://doi.org/10.1007/s40258-014-0127-4
21. Cheung JPY, Yiu K, et al. Mean 6-year follow-up of magnetically controlled growing rod patients with early onset scoliosis: a glimpse of what happens to graduates. Neurosurgery 2019;84(5):1112-23.
https://doi.org/10.1093/neuros/nyy270
22. Rushton PRP, Smith SL, Forbes L, Bowey AJ, Gibson MJ, Joyce TJ. Force testing of explanted magnetically
controlled growing rods. Spine (Phila Pa 1976) 2019;44(4):233-39. https://doi.org/10.1097/BRS.0000000000002806
23. Thompson GH, Akbarnia BA, Campbell RM Jr. Growing rod techniques in early-onset scoliosis. J Pediatr Orthop 2007;27:354-61. https://doi.org/10.1097/BPO.0b013e3180333eea
24. Heydar AM, Sirazi S, Bezer M. Magnetic controlled growing rods as a treatment of early onset scoliosis: early
results with two patients. Spine (Phila Pa 1976) 2016;41(22):E1336-E1342.
https://doi.org/10.1097/BRS.0000000000001614
25. Stokes OM, O’Donovan EJ, Samartzis D, Bow CH, Luk KDK, Cheung KMC. Reducing radiation exposure in earlyonset scoliosis surgery patients: novel use of ultrasonography to measure lengthening in magnetically-controlled growing rods. Spine J 2014;14:2397-2404. https://doi.org/10.1016/j.spinee.2014.01.039
1. Skaggs DL, Guillaume T, El-Hawary R, Emans J, Mendelow M, Smith J. Early Onset Scoliosis Consensus
Statement, SRS Growing Spine Committee. Spine Deform 2015;3(2):107. https://doi.org/10.1016/j.jspd.2015.01.002
2. Williams BA, Matsumoto H, McCalla JD, Akbarnia BA, Blakemore LC, Betz RR, et al. Development and initial
validation of the classification of early onset scoliosis (C-EOS). J Bone Joint Surg Am 2014;96(16):1359-67.
https://doi.org/10.2106/JBJS.M.00253
3. Campbell RM Jr, Smith MD. Thoracic insufficiency syndrome and exotic scoliosis. J Bone Joint Surg Am
2007;89(Suppl):108-22. https://doi.org/10.2106/JBJS.F.00270
4. Pehrsson K, Larsson S, Nachemson A. Long-term follow-up of patients with untreated scoliosis. A study of mortality, causes of death, and symptoms. Spine 1992;17(9):1091-6. https://doi.org/10.1097/00007632-199209000-00014
5. Vitale MG, Matsumoto H, Roye DP Jr., Bye MR, Gomez JA, Booker WA, et al. Pulmonary function, radiographic
measures, and quality of life in children with congenital scoliosis: an evaluation of patient outcomes after early
spinal fusion. Spine (Phila Pa 1976) 2008;33(11):1242-9. https://doi.org/10.1097/BRS.0b013e3181714536
6. Sankar WN, Acevedo DC, Skaggs DL. Comparison of complications among growing spinal implants. Spine (Phila Pa 1976) 2010;35(23):2091-6. https://doi.org/10.1097/BRS.0b013e3181c6edd7
7. Cheung KM, Cheung JP, Samartzis D, Mak K, Wong Y, Akbarnia BA, et al. Magnetically controlled growing rods
for severe spinal curvature in young children: a prospective case series. Lancet 2012;379:1967-74.
https://doi.org/10.1016/S0140-6736(12)60112-3
8. Skov ST, Wijdicks SPJ, Bünger C, Castelein RM, Li H, Kruyt MC. Treatment of early-onset scoliosis with a hybrid
of a concave magnetic driver (magnetic controlled growth rod) and a contralateral passive sliding rod construct with apical control: preliminary report on 17 cases. Spine J 2018;18(1):122-9. https://doi.org/10.1016/j.spinee.2017.06.027
9. Beaven A, Gardner AC, Spilsbury JB, Marks DS, Mehta JS, Newton-Ede M. Magnetically controlled growing rods:
the experience of mechanical failure from a single center consecutive series of 28 children with a minimum follow-up of 2 years. Asian Spine J 2018;12(5):794-802. https://doi.org/10.31616/asj.2018.12.5.794
10. Dannawi Z, Altaf F, Noordeen H, Harshavardhana NS, El Sebaie H. Early results of a remotely-operated magnetic growth rod in early-onset scoliosis. Bone Joint J Br 2013;95(1):75-80.
https://doi.org/10.1302/0301-620X.95B1.29565
11. Akbarnia BA, Pawelek JB, Sponseller PD, Cheung KM, Demirkiran G, Hazem El Sebaie H. et al. Traditional
growing rods versus magnetically controlled growing rods for the surgical treatment of early-onset scoliosis: a casematched 2-year study. Spine Deform 2014;2(6):493-7. https://doi.org/10.1016/j.jspd.2014.09.050
12. Bekmez S, Dede O, Yazici M. Advances in growing rods treatment for early onset scoliosis. Curr Opin Pediatr
2017;29(1):87-93. https://doi.org/10.1097/MOP.0000000000000432
13. Bess S, Akbarnia BA, Skaggs DL, Thompson GH, Sponseller PD, Shah SA, et al. Complications of growingrod
treatment for early-onset scoliosis: analysis of one hundred and forty patients. J Bone Joint Surg Am
2010;92(15):2533-43. https://doi.org/10.2106/JBJS.I.01471
14. La Rosa G, Oggiano L, Ruzzini L. Magnetically controlled growing rods for the management of early-onset
scoliosis: a preliminary report. J Pediatr Orthop 2017;37(2):79-85. https://doi.org/10.1097/BPO.0000000000000597
15. Yilmaz G, Huri G, Demirkran G, Dalolu K, Ozkan C, Alanay A, et al. The effect of posterior distraction on
vertebral growth in immature pigs: an experimental simulation of growing rod technique. Spine (Phila Pa 1976)
2010;35(7):730-3. https://doi.org/10.1097/BRS.0b013e3181bcc3a3
16. Tello CA. Harrington instrumentation without arthrodesis and consecutive distraction program for young children with severe spinal deformities. Experience and technical details. Orthop Clin North Am 1994;25:333-51.
PMID: 8159406
17. Wu AM, Cheung JPY, Cheung KMC, Lin JL, Jin HM, Chen D, et al. Minimum 2-year experience with magnetically
controlled growing rods for the treatment of early-onset scoliosis: a systematic review. Asian Spine J 2019; 13(4):
682-93. https://doi.org/10.31616/asj.2018.0272
18. Bekmez S, Afandiyev A, Dede O, Karaismailolu E, Demirkiran HG, Yazici M. Is magnetically controlled growing
rod the game changer in early-onset scoliosis? A preliminary report. J Pediatr Orthop 2019;39(3):e195-e200.
https://doi.org/10.1097/bpo.0000000000001268
19. Rolton D, Richards J, Nnadi C. Magnetic controlled growth rods versus conventional growing rod systems in the treatment of early onset scoliosis: a cost comparison. Eur Spine J 2015;24:1457-61.
https://doi.org/10.1007/s00586-014-3699-7
20. Jenks M, Craig J, Higgins J, Willits I, Barata T, Wood H, et al. The MAGEC system for spinal lengthening in
children with scoliosis: a NICE Medical Technology Guidance. Appl Health Econ Health Policy 2014;12:587-99.
https://doi.org/10.1007/s40258-014-0127-4
21. Cheung JPY, Yiu K, et al. Mean 6-year follow-up of magnetically controlled growing rod patients with early onset scoliosis: a glimpse of what happens to graduates. Neurosurgery 2019;84(5):1112-23.
https://doi.org/10.1093/neuros/nyy270
22. Rushton PRP, Smith SL, Forbes L, Bowey AJ, Gibson MJ, Joyce TJ. Force testing of explanted magnetically
controlled growing rods. Spine (Phila Pa 1976) 2019;44(4):233-39. https://doi.org/10.1097/BRS.0000000000002806
23. Thompson GH, Akbarnia BA, Campbell RM Jr. Growing rod techniques in early-onset scoliosis. J Pediatr Orthop 2007;27:354-61. https://doi.org/10.1097/BPO.0b013e3180333eea
24. Heydar AM, Sirazi S, Bezer M. Magnetic controlled growing rods as a treatment of early onset scoliosis: early
results with two patients. Spine (Phila Pa 1976) 2016;41(22):E1336-E1342.
https://doi.org/10.1097/BRS.0000000000001614
25. Stokes OM, O’Donovan EJ, Samartzis D, Bow CH, Luk KDK, Cheung KMC. Reducing radiation exposure in earlyonset scoliosis surgery patients: novel use of ultrasonography to measure lengthening in magnetically-controlled growing rods. Spine J 2014;14:2397-2404. https://doi.org/10.1016/j.spinee.2014.01.039