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Magnetically controlled growing rods safe, effective for scoliosis treatment in skeletally immature patients
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Use of a magnetically controlled growing rod for non-invasive outpatient distractions in the treatment of scoliosis in skeletally immature children is safe and effective, according to this study from researchers in China.
The researchers implanted a magnetically controlled growing rod (MCGR) in five skeletally immature patients with scoliosis, two of whom have reached the 24-month follow-up mark. Monthly outpatient distractions were performed on each patient, with the magnitude of spinal curvature, rod distraction length and spinal length all measured radiographically.
Clinical outcomes, the authors noted, were measured through degree of pain, function, mental health, treatment satisfaction and any procedure-related complications.
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According to the study, the mean degree of scoliosis — demonstrated via Cobb angle — was 67° prior to implantation and 29° at the 24-month follow-up. The instrumented segment of the spine was increased by a mean of 1.9 mm upon each distraction.
Both patients, according to the authors, reported no pain with good functional outcomes and satisfaction with the procedure. There were no MCGR-related complications.
“The MCGR procedure can be safely and effectively used in outpatient settings, minimizes surgical scarring and psychological distress, improves quality of life and is more cost-effective than the traditional growing rod procedure,” the authors wrote, adding the technique could be used for the non-invasive correction of abnormalities in other disorders.
Perspective
Back to TopAlvin H. Crawford, MD
Medical management with survival of very young children with significant scoliosis has improved to the point that early onset scoliosis of moderately high severity is being frequently seen by the pediatric spinal surgeon. Maintenance of and continuing spine growth is required for pulmonary development as well as aesthetics. Orthotics have offered few strategies to manage these children and multiple surgical approaches are being undertaken. One of the primary issues with all of the current technologies which may include stapling, tethers, limited surgical correction and guided growth, and implants that need repeated procedures is just that; the potential need for repeated procedures. The current crop of growing rods require “growing” (lengthening) possibly twice yearly, are invasive and at risk for complications similar to any procedure requiring multiple interventions.
These authors review their early experience with a technique which is similar yet mechanically different from a technology used in expanding limb salvage implants for children for malignancies. They cite validation of the implant in an animal model and further comment on the potential use of the technology for limb deformity correction. Lengthening can be performed with little discomfort to the patient on an outpatient basis and avoids the problems associated with multiple surgical interventions. They review 5 cases and have over 24 months follow-up on two, and infer a large-scale multicenter trial is underway.
Taken at face value this may represent a necessary leap forward in treating these patients. There are technical issues to be resolved regarding prediction and adequate achievement of distraction, monitoring of distraction without the radiation load, use of single vs. double rods, patient selection, etc. It’s a bit premature to comment on safety and efficacy of the device. Time and further experience (very small sample size) will determine how good this device is and how it adds to better treatment of humans with early onset severe scoliosis. Pediatric spines surgeons are anxiously awaiting its availability.
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Cheung KMC. Lancet. 2012. doi:10.1016/S0140-6736(12)60112-3
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