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Magnetically controlled growing rods in early onset scoliosis

Indications, timing and treatment

Magnetisch kontrollierte Wachstumsstäbe bei frühkindlicher Skoliose

Indikationen, Timing und Behandlung

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Abstract

Early onset scoliosis (EOS) remains one of the most challenging aspects of pediatric spine deformity care. The management is often complex, and options are non-operative care with casting or bracing and operative interventions. Surgical treatment includes distraction-based, compression-based and growth-guided techniques. The decision making should focus on preservation of growth, control of curve progression, minimizing complications, but most importantly improvement of the quality of life. Distraction-based techniques are the most commonly used growth-friendly surgery and the magnetically controlled growing rods (MCGR) technique is being utilized increasingly more in the USA over the past 10 years. The MCGR technique was cleared by the Food and Drug Administration (FDA) and available in the USA since 2014. It is indicated for the treatment of progressive EOS in immature patients and those at risk for thoracic insufficiency syndrome (TIS) with the goal of reducing the number of planned open surgical procedures for lengthening and minimizing the complications of more conventional techniques, such as traditional growing rods (TGR). The advent of MCGR has been a game changer for patients with EOS where the distractions are non-invasive and can be performed in outpatient clinics. Long-term follow-up is essential in understanding the outcome of any new treatment method especially in a very young and growing child. Multicenter registries with prospective data collection of pediatric spine deformity patients is imperative for understanding the outcomes of different methods of treatment, minimizing the complications and improving the quality of life of these children.

Zusammenfassung

Die frühkindliche Skoliose (EOS, „early onset scoliosis“) bleibt eine der größten Herausforderungen in der Versorgung kindlicher Wirbelsäulendeformitäten. Die Behandlung ist häufig komplex, wobei die Optionen von einer nichtoperativen Versorgung mit Gipsverbänden oder Bracing bis hin zu operativen Eingriffen reichen. Die chirurgische Behandlung umfasst distraktionsbasierte, kompressionsbasierte und wachstumsgeführte Techniken. Bei der Entscheidungsfindung sollte das Wachstum berücksichtigt, die Kurvenprogression kontrolliert, die Komplikationen minimiert und vor allem die Lebensqualität verbessert werden. Die Behandlung mit einem magnetisch kontrollierten Wachstumsstab (MCGR) kam in den letzten 10 Jahren in den immer häufiger zum Einsatz. Seit 2014 ist der MCGR von der Food and Drug Administration (FDA) zugelassen und auch in den USA verfügbar. Mit dieser Technik soll die Anzahl der geplanten Verlängerungsoperationen und die Komplikationen traditioneller Wachstumsstäbe (TGR) veringert werden. Die Einführung von MCGR hat für EOS-Patienten große Vorteile, da die Stabdistraktion nichtinvasiv und ambulant durchgeführt werden können. Der Langzeit-Follow-up ist essenziell für das Verständnis einer neuen Behandlungsmethode, insbesondere bei sehr jungen Kindern, die sich noch im Wachstum befinden. Ein Multizenterregister mit einer prospektiven Datensammlung über pädiatrische Patienten mit Wirbelsäulendeformitäten ist unabdingbar, um die Ergebnisse verschiedener Therapieverfahren zu verstehen, die Komplikationen zu minimieren und die Lebensqualität dieser Kinder zu verbessern.

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Abbreviations

AP:

Anteroposterior

BMI:

Body mass index

EOS:

Early onset scoliosis

ERC:

External remote controller

FDA:

Food and Drugs Administration

FEA:

Finite element analysis

MCGR:

Magnetically controlled growing rod

MMD:

MAGEC manual distractor

MML:

MAGEC magnet locator

MRI:

Magnetic resonance imaging

PD:

Diaphragmatic pacemaker

PEEK:

Poly-ether-ether-ketone

PJK:

Proximal junctional kyphosis

PJF:

Proximal junctional failure

TGR:

Traditional growing rods

TIS:

Thoracic insufficiency syndrome

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Authors and Affiliations

  1. Department of Orthopaedic Surgery, University of California, 6190 Cornerstone CT. #212, 92121, San Diego, CA, USA

    B. A. Akbarnia M.D.

  2. Department of Orthopedics, Scripps Clinic Medical Group, La Jolla, CA, USA

    G. M. Mundis Jr., M.D.

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Correspondence to B. A. Akbarnia M.D..

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Conflict of interest

B.A. Akbarnia acts as consultant and receives royalties from Nuvasive, San Diego, USA. G.M. Mundis acts as consultant, receives royalties and has stocks in Nuvasive.

For this article no studies with human participants or animals were performed by any of the authors. All studies performed were in accordance with the ethical standards indicated in each case.

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Akbarnia, B.A., Mundis, G.M. Magnetically controlled growing rods in early onset scoliosis. Orthopäde 48, 477–485 (2019). https://doi.org/10.1007/s00132-019-03755-0

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