No Benefits in Using Magnetically Controlled Growing Rod as Temporary Internal Distraction Device in Staged Surgical Procedure for Management of Severe and Neglected Scoliosis in Adolescents

Abstract

Background: Severe spinal curvatures (SSCs) in children and adolescents have long been treated with preoperative Halo traction, in its various variations. There are also several radical techniques available for the management of neglected SSCs, such as osteotomies; however, these can be risky. Comparing the treatment outcomes when using preoperative Halo Gravity Traction (HGT) against the use of a Magnetically Controlled Growing Rod (MCGR) as a temporary internal distraction (TID) device, we evaluated the differences in surgical and radiological outcomes. Methods: We conducted a retrospective study of 30 patients with SSCs, treated with HGT followed by posterior spinal fusion (PSF; Group 1, n = 18) or treated using a temporary MCGR as a TID followed by PSF (Group 2, n = 12). All patients underwent surgical treatment between 2016 and 2022. The inclusion criteria were SSC > 90°, flexibility < 30%, and the use of preoperative HGT followed by PSF or the two-stage surgical procedure with initial TID rod placement (Stage 1) followed by PSF (Stage 2). The evaluated parameters were as follows: rib hump, trunk height, and radiographic outcomes. All parameters were collected preoperatively, after the initial surgery, after final correction and fusion, and during the final follow-up. Results: In Group 1, we evaluated 18 patients with a mean age of 15.5 years; in Group 2, we evaluated 12 patients with a mean age of 14.2 years. The interval between the staged procedures averaged 32.7 days. The mean preoperative main curves (MC) were 118° and 112° in Group 1 and Group 2, respectively. After definitive surgery, the MC was corrected to 42° and 44° in G1 and G2, respectively. The mean percentage correction of the MC was similar in both groups (65% vs. 61% in G1 and G2, respectively). The mean preoperative thoracic kyphosis was 92.5° in G1 and 98° in G2, corrected to 43.8° in G1 and 38.8° in G2. Trunk height increased by 9 cm on average. Conclusions: There are no benefits in using a MCGR as a temporary internal distraction device in the management of neglected scoliosis in adolescents. Surgical treatment of severe scoliosis may be safe, with a reduced risk of potential complications, when using preoperative HGT. A specific intraoperative complication when using a MCGR as a temporary internal distraction device was a 50% risk of transient neuromonitoring changes, due to significant force applied to the spine and radical distraction of the spine. We achieved similar clinical, radiographic, and pulmonary function outcomes for both techniques. The use of HGT causes less blood loss with a shorter overall time under anesthesia. Partial correction significantly aids the subsequent operation by facilitating a gradual reduction in the curvature, thereby reducing the difficulty of surgical treatment and the risk of neurological deficits.

Radiological and Pulmonary Results of Surgical Treatment of Severe Idiopathic Scoliosis Using Preoperative Halo Gravity Traction Compared with Less Invasive Temporary Internal Distraction in Staged Surgery in Adolescents

“…Additionally, it aids in enhancing lung function by 9% [10,15,32,34,35], an outcome that aligns with those observed in our study's Group 1 patients. A notable benefit of HGT therapy is its cost-effectiveness, requiring fewer financial investments compared with implant utilization or the application of magnetically controlled growing rods for internal temporary traction, as discussed in various studies [11][12][13][14]20]. Nevertheless, a direct comparison of overall treatment expenses is challenging due to variations influenced by a country's healthcare system and insurance framework.…”

“…As an alternative to external traction techniques that use Halo traction, we can use internal traction-the TID method-in various configurations [16,19,20,24,[40][41][42]. We found that one study compared the outcomes of a Halo gravity traction course with temporary internal distraction [26].…”

“…This involved utilizing 8-10 pins to optimize distraction, thereby decreasing the likelihood of pin pullout and instability in the Halo ring during traction. Traction initiation commenced at 2-3 kg and was incrementally augmented to a maximum of 50% of the patient's body weight, mirroring protocols detailed in prior studies [4,10,20]. Subsequent to the completion of the HGT regimen, corrective measures for the spinal deformity were undertaken through a conventional posterior approach employing segmental screw instrumentation via a free-hand technique, alongside posterior column osteotomy, as documented in the pertinent literature [27][28][29][30][31].…”

“…The preferred treatment approach for severe and rigid spinal curvatures is the utilization of preoperative Halo gravity traction (HGT) [9][10][11][12][13][14][15]. However, various alternative methods have also been introduced for managing severe spinal deformities, such as temporary internal distraction (TID) and its various adaptations, anterior release (AR), posterior release (PR), and thoracoplasty with rib osteotomy (TP), as well as different forms of three-column osteotomies like pedicle subtraction osteotomy (PSO) and vertebrectomy (commonly known as vertebral column resection (VCR)) [16][17][18][19][20][21][22][23][24][25]. Techniques involving gradual traction, whether external or internal, are typically viewed as safer compared with the more aggressive three-column osteotomy (3CO) approach, with a confined and acceptable incidence of complications [3,4,6,[10][11][12][15][16][17]20,24,26].…”

“…There is a scarcity of studies within the medical literature that directly compare both methodologies for managing severe spinal deformities in the pediatric and adolescent populations, specifically the HGT strategy versus the less invasive temporary internal distraction rod technique [20,26]. Thus, the objective of this investigation was to assess two cohorts of patients undergoing treatment with these respective techniques to more accurately discern the variances in terms of surgical and radiological results, pulmonary function (PF), and quality of life (QoL).…”