Purpose Magnetically controlled growing rod systems have been introduced over recent years as an alternative to traditional growing rods for management of early onset scoliosis. The purpose of this paper is to report our early experience of a magnetically controlled growing rod system (MAGEC, Ellipse). Methods Review of pre-operative, postoperative and follow-up Cobb angles and spinal growth in case series of eight patients with a minimum 23 months' follow-up (23-36 months). Results A total of six patients had dual rod constructs implanted and two patients received single-rod constructs. Four patients had MAGEC rods as a primary procedure. Four were revisions from other systems. Mean age at surgery in the primary group was 4.5 years (range 3.9-6.9). In patients who had MAGEC as a primary procedure, mean pre-operative Cobb angle was 74°(63-94), with postoperative Cobb angle of 42°(32-56) p B 0.001 (43 % correction). Mean Cobb angle at follow-up was 42°(35-50). Spinal growth rate was 6 mm/year. One sustained proximal screw pull out. A final patient sustained a rod fracture. Mean age at surgery in the revision group was 10.9 years (range 9-12.6). Mean pre-operative Cobb angle was 45°( 34-69). Postoperative Cobb angle was 42°(33-63) (2 % correction). Mean Cobb angle at follow-up was 44°( 28-67). Mean spinal growth rate was 12 mm/year. Two patients developed loss of distraction.Conclusion MAGEC growing rod system effectively controls early onset scoliosis when used as either a primary or revision procedure. Although implant-related complications are not uncommon, the avoidance of multiple surgeries following implantation is beneficial compared with traditional growing rod systems.

IntroductionAbove the age of 70 years, fracture of the odontoid process is the most common cervical spine injury [8,9]. Unlike the younger population, in whom odontoid process fractures are caused by high-energy injuries, in the elderly population they are frequently caused by low-energy trauma like falls [8,10]. The classification system detailed by Anderson and D' Alonzo for odontoid process fractures is Abstract Odontoid fractures are common in the elderly following minor falls. Almost all of them have osteoarthritis of the cervical spine below the axis vertebra. As a result, there is increased stress on the spared upper cervical spine, resulting in a higher incidence of injuries. As movement in the upper cervical spine involves participation of five joints, degeneration in any one particular joint may affect the biomechanics of loading of the upper cervical spine. We aimed to analyse the relationship of odontoid fractures to the pattern of upper cervical spine osteoarthritis in the elderly. We studied the CT-scan images of the cervical spine in 23 patients who were over the age of 70 years and had odontoid fractures. In each patient, the type of odontoid fracture and the characteristics of the degenerative changes in each joint were analysed. Twenty-one of 23 patients had Type -II odontoid fractures. The incidence of significant atlanto-odontoid degeneration in these individuals was very high (90.48%), with relative sparing of the lateral atlantoaxial joints. Osteoporosis was found in 13 of 23 patients at the dens-body junction and in seven of 23 patients at

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This study highlights concerns with tissue metallosis in MCGR. We recommend careful follow-up of patients who have received this implant. Cite this article: Bone Joint J 2016;98-B:1662-7.

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