Contraindications to magnetically controlled growing rods: consensus among experts in treating early onset scoliosis

Matsumoto, Hiroko; Sinha, Rishi; Roye, Benjamin; Ball, Jacob; Skaggs, Kira; Brooks, Jaysson T.; Welborn, Michelle; Emans, John B.; Anari, Jason B.; Johnston, Charles E.; Akbarnia, Behrooz A.; Vitale, Michael G.; Murphy, Robert F.

doi:10.1007/s43390-022-00543-3

Cited by 7 publications

(8 citation statements)

References 46 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Although there are no studies confirming the toxic effects of this metallosis on soft tissues and the body, MCGR instruments should be removed at the end of the growth-promoting procedure, and final spine instrumentation should be made [ 27 , 29 ]. The use of MCGRs is still a safe and effective surgical technique in patients undergoing primary EOS surgery [ 5 , 6 , 7 , 10 , 17 , 18 , 22 , 23 , 32 , 33 , 34 , 35 , 36 ].…”

Section: Discussionmentioning

confidence: 99%

Less-Invasive Approach to Early-Onset Scoliosis—Surgical Technique for Magnetically Controlled Growing Rod (MCGR) Based on Treatment of 2-Year-Old Child with Severe Scoliosis

et al. 2023

View full text Add to dashboard Cite

Background: Spinal deformities in children can be caused by various etiologies, such as congenital, syndromic, neuromuscular, or idiopathic. Early-onset scoliosis (EOS) is diagnosed before the age of ten years, and when the curvature continues to progress and exceeds a Cobb angle of 60–65 degrees, surgical treatment should be considered. Initial minimally invasive surgery and the implantation of magnetically controlled growing rods (MCGRs) allows for the noninvasive distraction of the spine, growing, and avoids multiple operations associated with the classic distractions of standard growing rods. Case presentation: A 2-year-old girl was admitted to our clinic with rapidly progressive thoracic scoliosis. The major curve of the thoracic spine Cobb angle was 122° at 30 months. No congenital deformities were detected. The surgical technique was the less-invasive percutaneous and subfascial implantation of MCGRs, without long incisions on the back and the non-invasive ambulatory lengthening of her spine over the next 4 years. Conclusions: MCGR is a safe procedure for EOS patients. It is extremely effective at correcting spinal deformity; controlling the growth and curvature of the spine as the child develops during growth; reducing the number of hospitalizations and anesthesia; and minimizing the physical and mental burden of young patients, parents, and their families.

show abstract

Section: Discussionmentioning

confidence: 99%

Less-Invasive Approach to Early-Onset Scoliosis—Surgical Technique for Magnetically Controlled Growing Rod (MCGR) Based on Treatment of 2-Year-Old Child with Severe Scoliosis

et al. 2023

View full text Add to dashboard Cite

show abstract

“…Likewise, a multitude of other factors will work to hinder lengthenings of the MCGRs: hyperkyphosis, high BMI-values, curve stiffness, increase in rod length and curvature, child cooperation etc. 28 , 29 .…”

Section: Discussionmentioning

confidence: 99%

“…In a consensus study concerning contraindications to MCGR 29 , 71% of respondents agreed that patient size characteristics should be considered a contraindication but could not agree upon a specific BMI range or a specific spinal height range. The current study quantifies the implant depth problem, and our recommendation is that a distance from the skin to the MCGR ≥ 25 mm should be considered a relative contraindication for the use of an MCGR in EOS.…”

Section: Discussionmentioning

confidence: 99%

The magnetic field strength and the force distance dependency of the magnetically controlled growing rods used for early onset scoliosis

Diekhöner

Meyer

Eiskjær

2023

Sci Rep

View full text Add to dashboard Cite

Magnetically controlled growing rods (MCGR’s) have revolutionized the treatment of early-onset scoliosis (EOS) because painless lengthenings can be done in the outpatient clinic without anesthesia. Untreated EOS leads to respiratory insufficiency and reduced life expectancy. However, MCGR’s have inherent complications like non-functioning of the lengthening mechanism. We quantify an important failure mechanism and give advice on how to avoid this complication. The magnetic field strength was measured on new/explanted rods at different distances between the external remote controller and the MCGR and likewise in patients before/after distractions. The magnetic field strength of the internal actuator decayed fast with increasing distances and plateaued at 25–30 mm approximating zero. Two new and 12 explanted MCGRs was used for the lab measurements of the elicited force using a forcemeter. At a distance of 25 mm, the force was reduced to approximately 40% (ca. 100 N) compared to zero distance (ca. 250 N), most so for explanted rods. This is used to point out the importance of minimizing the implantation depth to ensure proper functionality of the rod lengthening in clinical use for EOS patients. A distance of 25 mm from skin to MCGR should be considered a relative contraindication to clinical use in EOS patients.

show abstract

“…Based on an expert consensus, inadequate skin and soft tissue cover, a stiff spinal curve, a sagittal curve apex above T3, hyperkyphosis, or patients requiring repetitive MRI for their care were recently defined as contraindications for the use of MCGR. 49 Whereas in parallel, a syndromic EOS patient without prior surgical treatment and the possibility of using a 90-mm actuator was declared an ideal candidate for MCGR. 50 The supposed cost savings of MCGR over TGR has also recently been questioned due to frequent reports of early implant failure 51 and by the latest Field Safety Notice (FSN) in December 2021 in Europe, urgently recommending to change or remove the implant(s) after implantation time of no more than 2 years (MAGEC and Precice systems CE Marks FAQs_7December2021_Final ( nuvasive.com )).…”

Section: Diagnosismentioning

confidence: 99%

Diagnostic and therapeutic strategies in early onset scoliosis: A current concept review

Studer,

Hasler

2024

Journal of Children's Orthopaedics

View full text Add to dashboard Cite

Substantial advances in the treatment of early onset scoliosis (EOS) over the past two to three decades have resulted in significant improvements in health-related quality of life of affected children. In addition to classifications that address the marked heterogeneity of this patient population, increasing understanding of the natural history of the disease, and new implants and treatment techniques have resulted in innovations unlike any other area of pediatric orthopedics. The growing understanding of the interaction between spinal and thoracic growth, as well as dependent lung maturation, has had a lasting impact on the treatment strategy of this potentially life-threatening disease. The previous treatment approach with early corrective fusion gave way to a growth-friendly concept. Despite the steady development of new growth-friendly surgical treatment options, whose efficacy still needs to be validated, as well as a revival of conservative growth control with serial casts and/or braces, the psychosocial burden of the long lasting and complication-prone treatments remains high. As a consequence, EOS still represents one of the greatest pediatric orthopedic challenges.

show abstract

Contraindications to magnetically controlled growing rods: consensus among experts in treating early onset scoliosis

Cited by 7 publications

References 46 publications

Less-Invasive Approach to Early-Onset Scoliosis—Surgical Technique for Magnetically Controlled Growing Rod (MCGR) Based on Treatment of 2-Year-Old Child with Severe Scoliosis

Less-Invasive Approach to Early-Onset Scoliosis—Surgical Technique for Magnetically Controlled Growing Rod (MCGR) Based on Treatment of 2-Year-Old Child with Severe Scoliosis

The magnetic field strength and the force distance dependency of the magnetically controlled growing rods used for early onset scoliosis

Diagnostic and therapeutic strategies in early onset scoliosis: A current concept review

Contact Info

Product

Resources

About