Mean 6-Year Follow-up of Magnetically Controlled Growing Rod Patients With Early Onset Scoliosis: A Glimpse of What Happens to Graduates

Neurosurgery ◽  
2018 ◽  
Vol 84 (5) ◽  
pp. 1112-1123 ◽  
Author(s):  
Jason Pui Yin Cheung ◽  
Karen Yiu ◽  
Kenny Kwan ◽  
Kenneth M C Cheung
Keyword(s):  
Cobb Angle ◽  
Early Onset ◽  
Skeletal Maturity ◽  
Reoperation Rate ◽  
Early Onset Scoliosis ◽  
Growing Rods ◽  
Initial Implantation ◽  
Magnetically Controlled Growing Rods ◽  
Magnetically Controlled Growing Rod

AbstractBACKGROUNDThere is no agreement on frequency of distractions of magnetically controlled growing rods (MCGRs) but more frequent and smaller amounts of distractions mimic physiological spine growth. The mid- to long-term follow-up and management at skeletal maturity is unknown.OBJECTIVETo analyze patients with mean 6 yr of follow-up and describe the fate of MCGR graduates.METHODSEarly onset scoliosis (EOS) patients treated with MCGRs with minimum 4 yr of follow-up and/or at graduation were studied. Parameters under study included Cobb angle, spine and instrumented lengths, and rod distraction gains. Relationship between timing of rod exchanges with changes in rate of lengthening was studied.RESULTSTen EOS patients with mean 6.1 yr of follow-up were studied. The greatest Cobb angle correction occurred at the initial implantation surgery and was stable thereafter. Consistent gains in T1-12, T1-S1, and instrumented segment were observed. Rate of lengthening reduced after the first year of use but improved back to initial rates after rod exchange. Seven of the ten patients experienced complications with reoperation rate of 40% for rod distraction failure and proximal foundation problems. Only mild further improvements in all radiological parameters were observed pre- and postfinal surgery. No clinically significant curve progression was observed for rod removal only. All postfinal surgery parameters remained similar at postoperative 2 yr.CONCLUSIONThis study provides an outlook of the end of MCGR treatment. Although this is a fusionless procedure, instrumented segments do experience stiffness limiting further correction and length gain during final surgery whether fusion or rod removal is performed.

scholarly journals Magnetically controlled growing rods in the treatment of early onset scoliosis

2020 ◽  
Vol 1 (7) ◽  
pp. 405-414
Author(s):  
Ahmed Abdelaal ◽  
Sudarshan Munigangaiah ◽  
Jayesh Trivedi ◽  
Neil Davidson
Keyword(s):  
Cobb Angle ◽  
Early Onset ◽  
Deformity Correction ◽  
Early Onset Scoliosis ◽  
Growing Rods ◽  
Angle Correction ◽  
Independent Risk Factors ◽  
The Mean ◽  
Magnetically Controlled Growing Rods

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. Results The mean Cobb angles pre-operatively, postoperatively, and at last follow-up were 70° (53 to 103), 35° (15 to 71) and 39° (15 to 65) respectively (p < 0.001). Further, there was a mean of 14° (-6 to 27) of additional Cobb angle correction upon graduation from MCGR to definitive fusion. Both T1-T12 and T1-S1 showed significant increase in heights of 27 mm and 45 mm respectively at last follow-up (p < 0.001). Ten children (23%) developed 18 complications requiring 21 unplanned operations. Independent risk factors for developing a complication were single rod constructs and previous revision surgery. Conclusion MCGR has the benefit of avoiding multiple surgeries, and is an effective tool in treatment of early-onset scoliosis. It also maintains the flexibility of the spine, allowing further correction at the time of definitive fusion. Cite this article: Bone Joint Open 2020;1-7:405–414.

scholarly journals Magnetically controlled growing rods in the treatment of early onset scoliosis

2020 ◽  
Vol 1 (7) ◽  
pp. 405-414
Author(s):  
Ahmed Abdelaal ◽  
Sudarshan Munigangaiah ◽  
Jayesh Trivedi ◽  
Neil Davidson
Keyword(s):  
Cobb Angle ◽  
Early Onset ◽  
Deformity Correction ◽  
Early Onset Scoliosis ◽  
Growing Rods ◽  
Angle Correction ◽  
Independent Risk Factors ◽  
The Mean ◽  
Magnetically Controlled Growing Rods

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. Results The mean Cobb angles pre-operatively, postoperatively, and at last follow-up were 70° (53 to 103), 35° (15 to 71) and 39° (15 to 65) respectively (p < 0.001). Further, there was a mean of 14° (-6 to 27) of additional Cobb angle correction upon graduation from MCGR to definitive fusion. Both T1-T12 and T1-S1 showed significant increase in heights of 27 mm and 45 mm respectively at last follow-up (p < 0.001). Ten children (23%) developed 18 complications requiring 21 unplanned operations. Independent risk factors for developing a complication were single rod constructs and previous revision surgery. Conclusion MCGR has the benefit of avoiding multiple surgeries, and is an effective tool in treatment of early-onset scoliosis. It also maintains the flexibility of the spine, allowing further correction at the time of definitive fusion. Cite this article: Bone Joint Open 2020;1-7:405–414.

scholarly journals Traditional growing rod for early-onset scoliosis in high-altitude regions: a retrospective study

2021 ◽  
Vol 16 (1) ◽  
Author(s):  
Haijun Jiang ◽  
Junrui Jonathan Hai ◽  
Peng Yin ◽  
Qingjun Su ◽  
Shiqi Zhu ◽  
...  
Keyword(s):  
Cobb Angle ◽  
High Altitude ◽  
Early Onset ◽  
Repeated Measures ◽  
Early Onset Scoliosis ◽  
Sacral Slope ◽  
Growing Rods ◽  
Initial Surgery ◽  
Radiographic Measurements

Abstract Background Children with early-onset scoliosis living in high-altitude areas have severe deformities and poor nutritional status. However, no reports on early-onset scoliosis treatment using traditional growing rods in such children exist. Thus, we analyzed the outcomes of traditional growing rods treatment in such patients and the effect of altitude on therapy. Methods Between September 2007 and December 2017, 59 consecutive patients with EOS underwent systematic surgical correction using traditional growing rods. They were divided into the high-altitude and low-altitude groups, and differences in surgical efficacy and complications between the groups were analyzed pre- and postoperatively. Radiographic measurements, including the Cobb angle, thoracic kyphosis, lumbar lordosis, T1–S1 and T1–T12 heights, sagittal and coronal balance, distance between C7PL and sagittal vertical axis, pelvic incidence, sacral slope, and pelvic tilt were assessed preoperatively, postoperatively, and at the last follow-up. Continuous data were analyzed using paired or independent Student’s t tests, and they were compared preoperatively, postoperatively, and at the last follow-up using a repeated measures analysis of variance. Enumerated data were analyzed using the χ2 test. Results The mean patient age at the initial surgery and mean follow-up duration were 8.9 ± 2.4(5–14) years and 51.91 ± 25.23 months, respectively. Altogether, 234 operations were conducted for all patients with an average interval between operations of 11.4 ± 3.0 months. The average Cobb angle was similar in both groups preoperatively and at the last follow-up, it was significantly different postoperatively. TK was significantly different in all three periods. T1–S1 and T1–T12 heights were significantly different only during the preoperative period. The overall rates of complications and implant-related complications did not differ significantly between the groups. Conclusions Deformity in patients with EOS in high-altitude areas was more severe, and treatment using TGRs yielded a satisfactory therapeutic effect.

scholarly journals Current status of the magnetically controlled growing rod in treatment of early-onset scoliosis: What we know after a decade of experience

2019 ◽  
Vol 27 (3) ◽  
pp. 230949901988694 ◽  
Author(s):  
Jason Pui Yin Cheung ◽  
Kenneth MC Cheung
Keyword(s):  
Early Onset ◽  
Skeletal Maturity ◽  
Clinical Effectiveness ◽  
Early Onset Scoliosis ◽  
Current Status ◽  
Wound Complications ◽  
Growing Rods ◽  
Growing Rod ◽  
Magnetically Controlled Growing Rod

The magnetically controlled growing rod (MCGR) has had approximately 10 years of clinical experience worldwide. Clinical effectiveness to control early-onset scoliosis is consistent even at final surgery. MCGRs have significantly lower relative percentage of infection or wound complications as compared to traditional growing rods. Most common complications include foundation failure and failure of distraction. Contouring of the rod especially at the proximal segment while accommodating for the straight actuator remains a difficult task and its failure may lead to proximal junctional kyphosis. Unique complications of MCGR include clunking, temporary diminishing distraction gains, and metallosis. Temporary reductions in distraction gains are observed as the MCGR lengthens but return to normal baseline distraction gains after rod exchange. Lack of standardization for rod configuration, distraction strategies and decisions of whether to keep the rods in situ, remove without fusion surgery or to perform spinal fusion at skeletal maturity will require further study.

Systematic investigation of metallosis associated with magnetically controlled growing rod implantation for early-onset scoliosis

2020 ◽  
Vol 102-B (10) ◽  
pp. 1375-1383
Author(s):  
Teng Zhang ◽  
K. Y. Sze ◽  
Z. W. Peng ◽  
Kenneth M. C. Cheung ◽  
Y. F. Lui ◽  
...  
Keyword(s):  
Early Onset ◽  
Systematic Investigation ◽  
Early Onset Scoliosis ◽  
Metal Contact ◽  
Tissue Samples ◽  
Growing Rods ◽  
Control Tissue ◽  
Metal On Metal ◽  
Magnetically Controlled Growing Rods ◽  
Magnetically Controlled Growing Rod

Aims To investigate metallosis in patients with magnetically controlled growing rods (MCGRs) and characterize the metal particle profile of the tissues surrounding the rod. Methods This was a prospective observational study of patients with early onset scoliosis (EOS) treated with MCGRs and undergoing rod exchange who were consecutively recruited between February 2019 and January 2020. Ten patients were recruited (mean age 12 years (SD 1.3); 2 M:8 F). The configurations of the MCGR were studied to reveal the distraction mechanisms, with crucial rod parts being the distractable piston rod and the magnetically driven rotor inside the barrel of the MCGR. Metal-on-metal contact in the form of ring-like wear marks on the piston was found on the distracted portion of the piston immediately outside the barrel opening (BO) through which the piston rod distracts. Biopsies of paraspinal muscles and control tissue samples were taken over and away from the wear marks, respectively. Spectral analyses of the rod alloy and biopsies were performed to reveal the metal constituents and concentrations. Histological analyses of the biopsies were performed with haematoxylin and eosin staining. Results Titanium (Ti), vanadium (V), and neodymium (Nd) concentrations in the biopsies taken near the wear marks were found to be significantly higher than those in the control tissue samples. Significantly increased Nd concentrations were also found in the tissues near the barrel of the MCGR. Chronic inflammation was revealed by the histological studies with fibrosis and macrophage infiltration. Black particles were present within the macrophages in the fibrotic tissues. Conclusion Ti and V were generated mainly at the BO due to metal-on-metal contact, whereas the Nd from the rotor of the MCGR is likely released from the BO during distraction sessions. Phagocytotic immune cells with black particles inside raise concern regarding the long-term implications of metallosis. Cite this article: Bone Joint J 2020;102-B(10):1375–1383.

scholarly journals Management and results of early-onset scoliosis with dual magnetically controlled growing rods: Additional preliminary results of spinal fusion surgery

2021 ◽  
Vol 32 (2) ◽  
pp. 478-488
Author(s):  
Ömer Faruk Kılıçaslan ◽  
Mehmet Ali Tokgöz ◽  
Şevket Bütün ◽  
Vugar Nabi ◽  
Serdar Akalın
Keyword(s):  
Spinal Fusion ◽  
Early Onset ◽  
Early Onset Scoliosis ◽  
Fusion Surgery ◽  
Growing Rods ◽  
Spinal Fusion Surgery ◽  
Length Increase ◽  
The Mean ◽  
Magnetically Controlled Growing Rods

Objectives: The aim of this study was to evaluate the clinical and radiographic outcomes and complications of dual magnetically controlled growing rods (MCGRs) in the treatment of early-onset scoliosis (EOS) and to investigate the results of patients with definitive spinal fusion following MCGR. Patients and methods: A total of 15 patients (7 males, 8 females; mean age: 8.7±1.7 years; range, 6 to 10 years) with EOS who underwent dual MCGR and were prospectively followed between February 2013 and March 2019 were included in this retrospective study. The Cobb angle, thoracic kyphosis, and the length of the spine between T1-T12 and T1-S1 were measured on preoperative, postoperative, and follow-up radiographs. The 24-Item Early-Onset Scoliosis Questionnaire (EOSQ-24) was used to assess the functional outcomes before and after the operation. All complications during the treatment were recorded. Results: The mean follow-up was 27.8±10.4 (range, 12 to 60) months. The mean curve correction immediately after the index surgery and latest follow-up was 47.6% and 42.4%, respectively (p>0.05). At the last follow-up, there were no significant changes in mean Cobb and kyphosis angles. The mean T1-T12 length increase was 26.2±7.1 (range, 16 to 40) mm, while the mean T1-S1 length increase was 43.3±15.0 (range, 24 to 70) mm. Complications developed in four (26.6%) of 15 patients. Definitive spinal fusion surgery was performed in seven patients. Total mean Cobb angle difference between the final follow-up and fusion surgery was 9.3° (p=0.016) and kyphosis angle difference was -2.1° (p=0.349). After fusion surgery, total lengthening in T1-T12 and T1-S1 distance was 10.5 mm (p=0.036) and 15.0 mm (p=0.022), respectively. A significant increase in all subdomain scores of the EOSQ-24 (p<0.05), except for financial impact, was recorded in all patients. Conclusion: Dual MCGR technique is an effective, reliable, and robust treatment alternative for primary EOS. However, surgeons should be aware of the relatively high rate of complications. In addition, residual deformity can be corrected successfully with definitive surgery.

scholarly journals Traditional Growing Rod for Early-Onset Scoliosis in High Altitude Regions: A Retrospective Study

2021 ◽  
Author(s):  
Haijun Jiang ◽  
Junrui Jonathan Hai ◽  
Peng Yin ◽  
Qingjun Su ◽  
Shiqi Zhu ◽  
...  
Keyword(s):  
Cobb Angle ◽  
High Altitude ◽  
Early Onset ◽  
Repeated Measures ◽  
Early Onset Scoliosis ◽  
Sacral Slope ◽  
Sagittal Vertical Axis ◽  
Growing Rods ◽  
Initial Surgery

Abstract Background：Children with early-onset scoliosis living in high-altitude areas have severe deformities and poor nutritional status.However, no reports on early-onset scoliosis treatment using traditional growing rods in such children exist. Thus, we analyzed the outcomes of traditional growing rods treatment in such patients and the effect of altitude on therapy.Methods：Between September 2007 and December 2017, 59 consecutive patients with EOS underwent systematic surgical correction using traditional growing rods.They were divided into the high-altitude and low-altitude groups, and differences in surgical efficacy and complications between the groups were analyzed pre- and postoperatively.Radiographic measurements,including the Cobb angle,thoracic kyphosis, lumbar lordosis, T1–S1and T1–T12 heights,sagittal and coronal balance, distance between C7PL and sagittal vertical axis,pelvic incidence,sacral slope, and pelvic tilt were assessed preoperatively, postoperatively, and at the last follow-up. Continuous data were analyzed using paired or independent Student’s t-tests, and they were compared preoperatively, postoperatively, and at the last follow-up using a repeated measures analysis of variance. Enumerated data were analyzed using the χ2 test.Results：The mean patient ageat the initial surgery and mean follow-up duration were 8.9±2.4(5–14) years and 51.91±25.23 months, respectively.Altogether, 234 operations were conducted for all patients with an average interval between operations of 11.4±3.0months.The average Cobb angle was similar in both groups preoperatively and at the last follow-up,it was significantly different postoperatively. TK was significantly different in all three periods.T1–S1 and T1–T12 heights were significantly different only during the preoperative period. The overall rates of complications and implant-related complications did not differ significantly between the groups.Conclutions：Deformity in patients with EOS in high-altitude areas was more severe, and treatment using TGRs yielded a satisfactory therapeutic effect.

scholarly journals Frequent Small Distractions with a Magnetically Controlled Growing Rod for Early-Onset Scoliosis and Avoidance of the Law of Diminishing Returns

2016 ◽  
Vol 24 (3) ◽  
pp. 332-337 ◽  
Author(s):  
Jason Pui Yin Cheung ◽  
Cora Bow ◽  
Dino Samartzis ◽  
Kenny Kwan ◽  
Kenneth Man Chee Cheung
Keyword(s):  
Cobb Angle ◽  
Early Onset ◽  
Early Onset Scoliosis ◽  
Growing Rod ◽  
Diminishing Returns ◽  
The Mean ◽  
The Law ◽  
Magnetically Controlled Growing Rod ◽  
Length Gain

Purpose To assess the effect of frequent small distractions with a magnetically controlled growing rod (MCGR) on spinal length gain and achieved distraction length in children with early-onset scoliosis (EOS), and to determine whether the law of diminishing returns applies to this group of patients with MCGR. Methods A consecutive series of 3 males and 4 females with EOS who underwent MCGR implantation at a mean age of 10.2 years and were followed up for a mean of 3.8 years were reviewed. Distraction was aimed at 2 mm monthly. The coronal Cobb angle, T1-S1 length gain, and achieved distraction length were measured at 6-monthly intervals. Results The mean total number of distractions was 31. Four of the patients had problems that may have affected distractions. The mean coronal Cobb angle improved post-operatively and was maintained throughout the follow-up period. The mean T1-S1 length gain and achieved distraction length varied over the follow-up period and did not diminish with repeated lengthening. Conclusions Frequent small distractions with the MCGR for EOS enable T1-S1 and achieved distraction length gain without significant reduction in gain after repeated lengthening.

scholarly journals Premature spinal fusion after insertion of magnetically controlled growing rods for treatment of early-onset scoliosis: illustrative case

2021 ◽  
Vol 2 (17) ◽  
Author(s):  
Anna H. Green ◽  
Andrzej Brzezinski ◽  
Terrence Ishmael ◽  
Stephen Adolfsen ◽  
J. Andrew Bowe
Keyword(s):  
Spinal Fusion ◽  
Early Onset ◽  
Early Onset Scoliosis ◽  
Illustrative Case ◽  
Body Habitus ◽  
Growing Rods ◽  
Growing Rod ◽  
Magnetically Controlled Growing Rods ◽  
Magnetically Controlled Growing Rod

BACKGROUND Magnetically controlled growing rod (MCGR) systems have gained attention for their use in the treatment of early-onset scoliosis. Although traditional growing rods require frequent operations to lengthen the construct, MCGR allows for fewer open procedures and more frequent distractions by externally controlling rod elongation. Despite its appealing advantages, MCGR is not without limitations. OBSERVATIONS The authors describe a case of premature spinal autofusion before growing rod removal and termination of rod distraction. LESSONS This case highlights the limitations of MCGR systems, including length of use, body habitus restrictions, and risk of autofusion.

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