Standard and magnetically controlled growing rods for the treatment of early onset scoliosis

Abstract

Distraction based spinal instrumentation represents the most common and standard surgical technique to correct early onset scoliosis (EOS), i.e., scoliosis which has been diagnosed before the age of 10 years. Surgical treatment of EOS aims at controlling spinal deformity while maintaining spinal growth which is mandatory for the development of normal lung capacity. To achieve these goals the spinal instrumentation needs to be distracted to facilitate spinal growth during treatment. Distraction can be obtained by repeated surgical lengthenings (traditional growing rods, TGRs) or using magnetically controlled growing rods (MCGRs), which can be lengthened using external remote controller on an outpatient basis.The outcomes of TGR instrumentation for EOS are well described with follow-up until skeletal maturity: normal spinal growth can be maintained, 40-50% of the scoliosis can be corrected, but there is an over 50% risk of complications including deep wound infection, rod failure, and instrumentation pull-out. MCGR instrumentation may reduce the risk of wound related complications, provides similar deformity correction, but may not provide as much spinal growth. Metallosis around the instrumentation necessitates MCGR removal and definitive final instrumented fusion at the end of growth friendly management. Even severe EOS can be treated using distraction based spinal instrumentation.

Video-Assisted Thoracoscopy for Vertebral Body Tethering of Juvenile and Adolescent Idiopathic Scoliosis: Tips and Tricks of Surgical Multidisciplinary Management

“…The technique of vertebral body tethering was designed to avoid these disadvantages. Although other recently described techniques seem promising in the management of IS, such as traditional growing rods or magnetically controlled growing rods, which are designed for the growing body and allow the correction to be modulated even in an outpatient setting, there are still many aspects that have to be adequately investigated and further studies are needed [ 8 , 9 ]. Minimally invasive surgery (MIS) continues to grow in popularity in all fields of pediatric surgery, including in the treatment of vertebral spine.…”

“…Degenerative disc disease can be documented at long term follow-up after spinal fusion, mainly at the lumbar level, although literature is not conclusive at this regard [ 7 ]. Other promising surgical treatments for IS have also been described in the literature, including traditional growing rods or magnetically controlled growing rods, which can be lengthened using external remote controller on an outpatient basis, developed in the last decade but still burdened by high complication and failure rates [ 8 , 9 ]. Anterior vertebral body tethering (AVBT) is a relatively recent technique, initially described by Crawford and Lenke [ 10 ], that allows gradual curve correction by changing the shape of the vertebra, while preserving spine mobility, with minimal associated morbidity [ 11 , 12 , 13 ].…”

Bewegungserhaltende operative Korrektur der idiopathischen Adoleszentenskoliose – Evidenz

“…Die verschiedenen dorsalen wachstumslenkenden Systeme sind heute gut etabliert und erlauben neben einer Korrektur Längenwachstum und die so wichtige Entfaltung des Thorax. In der überwiegenden Zahl der Fälle erfordern sie aber eine abschließende Korrekturoperation mit Fusion und dem damit einhergehendem Funktionsverlust [2,3].…”

Benefits of Fixing 3 Proximal Vertebral Bodies vs. 2 in the Treatment of Early-Onset Scoliosis with Growing Rods

“…4 Different from the traditional surgical methods of fusion and xation, the main features of the growing rod technique are "non-fusion and repetitive distraction for lengthening", which can control scoliosis while maintaining growth of the spine. 5 In addition, the nal spinal fusion operation can be performed after skeletal maturity. 6 In the growing rod technique, anchoring devices are placed at both ends of the spinal curvature, and the growing rod is placed between the ipsilateral anchoring devices.…”