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

Abstract

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.

Radiological Outcomes of Magnetically Controlled Growing Rods for the Treatment of Children with Various Etiologies of Early-Onset Scoliosis—A Multicenter Study

“…This is important for constitutional growth, such as lung development and respiratory efficiency. The available literature regarding the growth rate of the T1–T12 segment of the spine is diverse, ranging from 1.5 to 13.2 mm/year [ 12 , 17 , 23 , 24 , 25 , 26 , 27 , 28 , 29 ]. The average T1–T12 increase during the observation period in our group of patients was 5.95 mm/year, which is similar to the values obtained by Subramanian et al [ 30 ] and Cheung et al [ 16 ].…”

“…Our surgical technique was a less-invasive approach to the spine with two short incisions, one on the top and one on the bottom spine, with segmental screws and hooks used on the top, segmental screws put on the bottom, and subfascial insertion of MCGRs as described by Grabala et al [ 17 ] and Chamberlain at al. [ 18 ].…”

“…[ 18 ]. Our postoperative distraction protocol for MCGRs was similar to other cases of postoperative lengthening described in the literature [ 17 , 23 , 24 , 25 ] and was adapted for our patients. For all patients, we ordered a brace for three months.…”

“…Developed in 2009, magnetically controlled growing rods (MCGRs) were intended to improve treatment and minimize the risk of complications, and especially to reduce the number of repeated surgeries and anesthesia performed to extend the instrumentation for standard growing rods [ 11 , 12 , 13 , 14 , 15 , 16 ]. The surgical technique itself is minimally invasive, requiring only two mini-incisions in the upper and lower spine, and the rods are attached submuscularly or subfascially to the spine using pedicle screws or hooks to connect the proximal and distal bases and placed rods [ 17 , 18 ]. After the initial surgery with the insertion of the MCGRs, rod distraction is performed without anesthesia, using only special equipment, i.e., an external remote control (ERC), without repeated operations.…”

Early-onset scoliosis

“…Usually between three and six lengthenings are needed and can be spaced between 3 to more than 12 months [19]. The surgical technique has been widely described in the literature [20] with different variations depending on patient characteristics and surgeon's experience and preferences [21]. Zhao et al [22] proposed an alternative method with a TGR in conjunction to apical derotation screws on the apex of the convexity.…”