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Mehta J, Shah S, Hothi H, Tognini M, Gardner A, Johnston CE, Murphy R, Thompson G, Sponseller P, Emans J, Javier-Grueso F, Strum P. Outcome of distraction-based growing rods at graduation: a comparison of traditional growing rods and magnetically controlled growing rods. Spine Deform 2024:10.1007/s43390-024-00969-x. [PMID: 39313723 DOI: 10.1007/s43390-024-00969-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2024] [Accepted: 09/03/2024] [Indexed: 09/25/2024]
Abstract
INTRODUCTION Distraction-based growing rods have been considered as an alternative surgical option for the operative treatment of EOS. TGR has been challenged by MCGR, which is reported to have the advantage of non-invasive lengthening with fewer planned returns to theatre. This study explores the radiographic outcomes, Unplanned Returns to the Operating Room (UPROR) and complication profile of both the procedures at the end of the planned growing rod treatment with either TGR or MCGR. METHODS We included all the EOS cases from the PSSG database that underwent either TGR or MCGR with spine-based proximal anchors, followed up to the time of graduation. Any crossover or hybrid procedures were excluded. 549 patients (409 TGR and 140 MCGR) were eligible for review. We measured the coronal curve magnitude, Kyphosis, T1-T12, T1-S1 and L1-S1 lengths at 4 time points (before and after the index surgery and before and after the definitive surgery). RESULTS The TGR group were slightly younger at the time of the index procedure (7 years for TGR vs. 8.5 years for MCGR, p < 0.001). We noted an improvement in all radiological parameters after the growing rod implantation. The spinal lengths increased through the lengthening period, while the coronal curve magnitude and the kyphosis increased. The kyphosis normalized following the final fusion, the coronal curve magnitude reduced further with a further increase in spinal lengths. The final follow-up from the time of the index implantation to the definitive surgery was 5.1 years (IQR 3.8) in TGR and 3.5 years (IQR 1.65) in the MCGR groups. The total number of complications was fewer in the MCGR group. The overall risk of UPROR was lower in the MCGR group and implant breakage was less in the MCGR group by 4.7 times. CONCLUSIONS This study confirms the equivalence of both the distraction-based growing rods systems from the radiological stand-point, during the lengthening phase and at the time of the definitive surgery. The TGR was more kyphogenic during the lengthening period. The complications and UPROR were fewer in the MCGR groups.
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Affiliation(s)
- Jwalant Mehta
- Royal Orthopaedic Hospital, Spinal Unit, Birmingham, England.
| | - Suken Shah
- Nemours Childrens' Hospital, Delaware, Wilmington, DE, 19803, USA
| | - Harry Hothi
- Mechanical Engineering Department, University College London, London, England
| | - Martina Tognini
- Mechanical Engineering Department, University College London, London, England
| | - Adrian Gardner
- Royal Orthopaedic Hospital, Spinal Unit, Birmingham, England
| | | | - Robert Murphy
- Department of Orthopaedics and Physical Medicine, Medical University of South Carolina, Charleston, SC, USA
| | - George Thompson
- Rainbow Babies and Childrens' Hospital, Case Western Reserve University, Cleveland, OH, USA
| | | | - John Emans
- Boston Childrens' Hospital, Boston, MA, USA
| | | | - Peter Strum
- Cincinnati Childrens Hospital, Cincinnati, OH, USA
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Rios F, Elsebaie HB, Shahidi B, Ames R, Monjazeb B, Kerr W, Pahys JM, Hwang SW, Samdani AF, Andras LM, Oetgen ME, Newton PO, Yaszay B, Mundis GM, Akbarnia BA. Proximal foundation anchor variations and their correlation with unplanned return to the operating room (UPROR) in children with EOS treated with magnetically controlled growing rods (MCGR). Spine Deform 2024:10.1007/s43390-024-00921-z. [PMID: 38997612 DOI: 10.1007/s43390-024-00921-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2024] [Accepted: 06/16/2024] [Indexed: 07/14/2024]
Abstract
INTRODUCTION The evolution of MCGR technique has led to modifications in the configuration of the proximal construct to decrease the incidence of implant-related complications (IRC) and revision surgeries. However, there is no data characterizing the performance of the most used configurations reducing the risk of complications. METHODS 487 patients were identified from an international multicenter EOS database. INCLUSION CRITERIA EOS patients, primary dual MCGR, complete radiographs, and minimum of 2-year follow-up. 76 patients had incomplete X-rays, 5 had apical fusions, and 18 had inconclusive complications, leaving 388 patients for review. A digital spine template was created to document UIV; number of levels; number, type, and location of anchors; as well as implant configuration. First available postoperative and latest follow-up radiographs were reviewed by two senior surgeons and two spine fellows. UPROR due to IRC was defined as any change in proximal anchors between the postoperative and final follow-up radiographs. RESULTS The most common proximal construct configuration: UIV at T2 (50.0%) with 17.5% UPROR, followed by T3 (34.0%) with 12.1% UPROR; number of levels was three (57.1%) with 16.8% UPROR and two (26.0%) with 17.0% UPROR; number of proximal anchors was six (49.9%) with 14.1% UPROR and four (27.0%) with 18.3% UPROR. The most common anchors were all screws (42.0%) with 9.9% UPROR, and all hooks (26.4%) with 31.4% UPROR (P < 0.001). The construct with the lowest rate of UPROR was a UIV at T2, with six anchors (all screws) across three levels (42 cases), with 0% UPROR. Other construct combinations that yielded 0% UPROR rates were UIV of T3, six anchors (all screws) across three levels (25 cases), and a UIV of T3 with six anchors (screws and hooks) across three3 levels (9 cases). CONCLUSION Proximal anchor configuration impacts the incidence of UPROR due to IRC in MCGR. UIV at T2 and T3 compared to T4, and the use of all screws or combination of screws and hooks compared to all hooks were associated with a lower UPROR rate. The most common construct configuration was T2 UIV, three levels, six anchors, and all screws. The use of a combination of six anchors (screws or screws and hooks) across three levels with a UIV at T2 or T3 was associated with a lower UPROR rate. Additional research is needed to further evaluate the variables contributing to configuration selection and their association with IRC.
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Affiliation(s)
- Fernando Rios
- San Diego Spine Foundation, 6190 Cornerstone CT #212, San Diego, CA, 92121, USA
| | - Hazem B Elsebaie
- San Diego Spine Foundation, 6190 Cornerstone CT #212, San Diego, CA, 92121, USA
| | - Bahar Shahidi
- San Diego Spine Foundation, 6190 Cornerstone CT #212, San Diego, CA, 92121, USA
- University of California, San Diego, CA, USA
| | - Robert Ames
- San Diego Spine Foundation, 6190 Cornerstone CT #212, San Diego, CA, 92121, USA
| | - Bailee Monjazeb
- San Diego Spine Foundation, 6190 Cornerstone CT #212, San Diego, CA, 92121, USA
| | - William Kerr
- San Diego Spine Foundation, 6190 Cornerstone CT #212, San Diego, CA, 92121, USA
| | | | | | | | | | | | | | - Burt Yaszay
- Seattle Children's Hospital, Seattle, WA, USA
| | - Gregory M Mundis
- San Diego Spine Foundation, 6190 Cornerstone CT #212, San Diego, CA, 92121, USA
- Scripps Clinic, La Jolla, CA, USA
| | - Behrooz A Akbarnia
- San Diego Spine Foundation, 6190 Cornerstone CT #212, San Diego, CA, 92121, USA.
- University of California, San Diego, CA, USA.
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Glowka P, Grabala P, Gupta MC, Pereira DE, Latalski M, Danielewicz A, Grabala M, Tomaszewski M, Kotwicki T. Complications and Health-Related Quality of Life in Children with Various Etiologies of Early-Onset Scoliosis Treated with Magnetically Controlled Growing Rods-A Multicenter Study. J Clin Med 2024; 13:4068. [PMID: 39064107 PMCID: PMC11277853 DOI: 10.3390/jcm13144068] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2024] [Revised: 07/08/2024] [Accepted: 07/09/2024] [Indexed: 07/28/2024] Open
Abstract
Background: Early-onset scoliosis (EOS) refers to spinal deformities that develop and are diagnosed before the age of 10. The most important goals of the surgical treatment of EOS are to stop the progression of curvature, achieve the best possible correction, preserve motion, and facilitate spinal growth. The objectives of this multicenter study were to analyze the risk of complications among patients with EOS treated using magnetically controlled growing rods (MCGRs) and assess the patients' and their parents' quality of life after diagnosis and treatment with a minimum two-year follow-up. Methods: Patients given an ineffective nonoperative treatment qualified for surgery with MCGRs. This study involved 161 patients (90 females and 71 males) who were classified according to the etiology of curvature. The intraoperative and postoperative complications and those that occurred during the continuation of treatment with MCGRs were recorded and analyzed. The 24-item Early-Onset Scoliosis Questionnaire (EOSQ-24) was used to evaluate the patients' quality of life and satisfaction with the treatment. Results: Implant-related complications requiring instrumentation revision were recorded in 26% of the patients. Medical complications occurred in 45% of the population. The EOSQ-24 revealed a significant improvement in the average scores during the follow-up. Conclusions: The treatment of early-onset scoliosis with MCGRs carries 66% risks of incurring medical and mechanical complications, the latter 26% of patients requiring revision procedures. Children with neuromuscular scoliosis, females, and with curvature greater than 90 degrees are at a higher risk of developing complications. Limiting the number of elective surgeries necessitated to prolong the instrumentation and treatment process for patients with MCGRs can greatly enhance their quality of life and satisfaction throughout the follow-up period.
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Affiliation(s)
- Pawel Glowka
- Department of Spine Disorders and Pediatric Orthopaedics, Poznań University of Medical Sciences, 28 Czerwca 1956 r. Street, no. 135/147, 61-545 Poznań, Poland; (P.G.); (M.T.); (T.K.)
| | - Pawel Grabala
- Department of Pediatric Orthopedic Surgery and Traumatology, University Children’s Hospital, Waszyngtona 17, 15-274 Bialystok, Poland
- Paley European Institute, Al. Rzeczypospolitej 1, 02-972 Warsaw, Poland
| | - Munish C. Gupta
- Department of Orthopaedic Surgery, Washington University in St. Louis, 660 S Euclid Ave., St. Louis, MO 63110, USA; (M.C.G.); (D.E.P.)
| | - Daniel E. Pereira
- Department of Orthopaedic Surgery, Washington University in St. Louis, 660 S Euclid Ave., St. Louis, MO 63110, USA; (M.C.G.); (D.E.P.)
| | - Michal Latalski
- Paediatric Orthopaedic Department, Medical University of Lublin, Gebali 6, 20-093 Lublin, Poland; (M.L.); (A.D.)
| | - Anna Danielewicz
- Paediatric Orthopaedic Department, Medical University of Lublin, Gebali 6, 20-093 Lublin, Poland; (M.L.); (A.D.)
| | - Michal Grabala
- 2nd Clinical Department of General and Gastroenterogical Surgery, The Medical University of Bialystok Clinical Hospital, Medical University of Bialystok, M. Skłodowskiej-Curie 24a, 15-276 Bialystok, Poland;
| | - Marek Tomaszewski
- Department of Spine Disorders and Pediatric Orthopaedics, Poznań University of Medical Sciences, 28 Czerwca 1956 r. Street, no. 135/147, 61-545 Poznań, Poland; (P.G.); (M.T.); (T.K.)
| | - Tomasz Kotwicki
- Department of Spine Disorders and Pediatric Orthopaedics, Poznań University of Medical Sciences, 28 Czerwca 1956 r. Street, no. 135/147, 61-545 Poznań, Poland; (P.G.); (M.T.); (T.K.)
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Mehta JS, Tognini M, Hothi H. Growing rods in Early Onset Scoliosis: The current scenario. J Orthop 2023; 42:63-69. [PMID: 37519912 PMCID: PMC10372050 DOI: 10.1016/j.jor.2023.07.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2023] [Revised: 07/12/2023] [Accepted: 07/14/2023] [Indexed: 08/01/2023] Open
Abstract
Background and aims The treatment of early onset scoliosis is a challenge. Some curves resolve spontaneously, while the more aggressive ones require surgical intervention. Several surgical strategies have been explored in this unique group of patients, though the distraction based growing rods are the mainstay of treatment. The aim of this paper is to consider the current scenario with the surgical treatment for early onset scoliosis with growing rods. Methods This is a narrative review that explores the various types of growing rod options that are currently available. The results, as reported in literature, are discussed. The complications and problems with the commonly used growing rods are explored, based on the reported literature and on retrieval analysis that we have published. We discuss some of the newer modifications of growing rods. Results There is no real consensus on the ideal timing for the surgery or ways to assess the outcomes of the treatment. The Cobb angle measurement and measures of thoracic growth are surrogate markers. The main indication for surgery is to an increase in the thoracic dimensions and allowing for lung growth. Measures that are linked to lung function are more useful. We report some newer MRI scanning technology. Distraction-based growing rods have been reported to produce consistent and good results. Frequent return to theatre with the Traditional Growing Rods (TGR) and the metallosis related problems with the MCGR are reported. Conclusions We have learned a lot from the TGR and MCGR experiences. There is a scope for ongoing research to improve the design of the implant systems and better assess the outcomes on lung function. This review outlines these and helps identify the future trends.
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Affiliation(s)
- Jwalant S. Mehta
- Royal Orthoapedic Hospital, UK
- Birmingham Childrens' Hospital, UK
| | - Martina Tognini
- Institute of Orthopaedics and Musculoskeletal Science, University College London, UK
- Royal National Orthopaedic Hospital, Brockley Hill, Stanmore, HA7 4LP, UK
| | - Harry Hothi
- Royal National Orthopaedic Hospital, Brockley Hill, Stanmore, HA7 4LP, UK
- Department of Mechanical Engineering, University College London, UK
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Guldeniz O, Yip CCH, Nafo W, Cheung KMC. Biomechanics of the tether breakage: tensile behaviour of a single-unit vertebral body tethering construct. Spine Deform 2023; 11:825-831. [PMID: 36763247 PMCID: PMC10261170 DOI: 10.1007/s43390-023-00657-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2022] [Accepted: 01/29/2023] [Indexed: 02/11/2023]
Abstract
PURPOSE Tether breakage was reported as the most common complication of vertebral body tethering. However, as the literature suggests the physiological loads do not have the potential to cause the failure of the tether. Currently, the biomechanical reason behind the tether breakage is unknown. The current study aims to elucidate the effects of the tension forces on the failure mechanisms of the VBT and provide mechanical justification for how it can be identified radiographically. METHODS Tensile tests (20%/min strain rate) were performed on single-unit VBT samples. Failure modes and mechanical characteristics were reported. RESULTS The failure took place prematurely due to the slippage of the tether at the screw-tether junction where the tether is damaged significantly by the locking cap. Slippage was initiated at 10-13% tensile strain level where the tensile stress and tension force were 50.4 ± 1.5 MPa and 582.2 ± 30.8 N, respectively. CONCLUSION The failure occurs because of high-stress concentrations generated within the locking region which damages the tether surface and leads to the slippage of the tether. We observed that the loads leading to failure are within the physiological limits and may indicate the high likelihood of the tether breakage. The failure mode observed in our study is shown to be the dominant failure mode, and a design improvement on the gripping mechanism is suggested to avoid failure at the screw-tether junction. We observed that the tether elongates 10-13% prior to the breakage, which can be employed as a diagnostic criterion to screen for tether breakages radiographically.
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Affiliation(s)
- Ogulcan Guldeniz
- Department of Orthopaedics and Traumatology, The University of Hong Kong, Pokfulam, Hong Kong SAR, China
| | - Christopher C H Yip
- Department of Orthopaedics and Traumatology, The University of Hong Kong, Pokfulam, Hong Kong SAR, China
| | - Wanis Nafo
- Department of Mechanical System Engineering, Jeonbuk National University, Jeonju, Republic of Korea
| | - Kenneth M C Cheung
- Department of Orthopaedic Surgery, HKU-Shenzhen Hospital, Shenzhen, China.
- Department of Orthopaedics and Traumatology, The University of Hong Kong, Pokfulam, Hong Kong SAR, China.
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Shaw KA, Jamnik A, McClung A, Thornberg D, Ramo B, McIntosh A. Increasing soft tissue depth is associated with stalling of magnetically controlled growing rods. NORTH AMERICAN SPINE SOCIETY JOURNAL 2023; 14:100230. [PMID: 37334188 PMCID: PMC10275716 DOI: 10.1016/j.xnsj.2023.100230] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Revised: 05/08/2023] [Accepted: 05/10/2023] [Indexed: 06/20/2023]
Abstract
Background Magnetically controlled growing rods (MCGR) represent the most used implant for the treatment of early onset scoliosis (EOS). These implants lengthen through the application of a remote magnetic field but distraction force generation has been negatively correlated with increasing soft tissue depth. Given the high rate of MCGR stalling, we proposed to investigate the impact of preoperative soft tissue depth on the rate of MCGR stalling at a minimum of 2 years following implantation. Methods A single-center, retrospective review of prospectively enrolled children with EOS treated with MCGR was performed. Children were included if they had a minimum of 2-years follow-up after implantation and underwent advanced spinal imaging (MRI or CT) preoperatively within a year of implantation. The primary outcome was the development of MCGR stall. Additional measures included radiographic deformity parameters and gain in MCGR actuator length. Results About 55 patients were identified with 18 having preoperative advanced imaging allowing tissue depth measurement (Mean 5.99 ± 1.9 years, 83.3% female, mean Cobb 68.6 ± 13.8°). At a mean follow-up of 46.1 ± 11.9 months, 7 patients (38.9%) experienced stalling. MCGR stalling was associated with increased preoperative soft tissue depth (21.5 ± 4.4 mm vs. 16.5 ± 4.1 mm; p = .025) and increased BMI (16.3 ± 1.6 vs. 14.5 ± 0.9; p = .007). Conclusions Greater preoperative soft tissue depth and BMI were associated with the development of MCGR stalling. This data supports previous studies showing that the distraction capacity of MCGR diminishes with increased soft tissue depth. Further research is needed to validate these findings and their implications on the indications for MCGR implantation.
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Affiliation(s)
- K. Aaron Shaw
- Corresponding author. Department of Pediatric Orthopedic Surgery, Scottish Rite for Children Hospital, 2222 Welborn St, Dallas, TX, USA.
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Tognini M, Hothi H, Bergiers S, Broomfield E, Tucker S, Henckel J, Hart A. Rod Fracture in Magnetically Controlled Growing Spine Rods. J Pediatr Orthop 2023; 43:211-217. [PMID: 36737055 PMCID: PMC9981316 DOI: 10.1097/bpo.0000000000002361] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
BACKGROUND The mechanisms of fracture in magnetically controlled growing rods (MCGRs) and the risk factors associated with this are poorly understood. This retrospective analysis of explanted MCGRs aimed to add understanding to this subject. METHODS From our cohort of over 120 retrieved MCGRs, we identified 7 rods that had fractured; all were single-rod constructs, retrieved from 6 patients. These were examined and compared with 15 intact single-rod constructs. Retrieval and fractographic analyses were used to determine the failure mode at the fracture site and the implant's functionality. Cobb angle, degree of rod contouring, and the distance between anchoring points were computed on anteroposterior and lateral radiographs. RESULTS 5/7 versus 3/15 rods had been inserted after the removal of a previously inserted rod, in the fractured versus control groups. All fractured rods failed due to bending fatigue. Fractured rods had greater rod contouring angles in the frontal plane ( P = 0.0407) and lateral plane ( P = 0.0306), and greater distances between anchoring points in both anteroposterior and lateral planes ( P = 0.0061 and P = 0.0074, respectively). CONCLUSIONS We found all failed due to a fatigue fracture and were virtually all single rod configurations. Fracture initiation points corresponded with mechanical indentation marks induced by the intraoperative rod contouring tool. Fractured rods had undergone greater rod contouring and had greater distances between anchoring points, suggesting that it is preferable to implant double rod constructs in patients with sufficient spinal maturity to avoid this complication. CLINICAL RELEVANCE Level III.
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Affiliation(s)
- Martina Tognini
- Royal National Orthopaedic Hospital and Institute of Orthopaedics and Musculoskeletal Science, University College London, Stanmore
| | - Harry Hothi
- Royal National Orthopaedic Hospital and Institute of Orthopaedics and Musculoskeletal Science, University College London, Stanmore
| | - Sean Bergiers
- Royal National Orthopaedic Hospital and Institute of Orthopaedics and Musculoskeletal Science, University College London, Stanmore
| | - Edel Broomfield
- Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - Stewart Tucker
- Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - Johann Henckel
- Royal National Orthopaedic Hospital and Institute of Orthopaedics and Musculoskeletal Science, University College London, Stanmore
| | - Alister Hart
- Royal National Orthopaedic Hospital and Institute of Orthopaedics and Musculoskeletal Science, University College London, Stanmore
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The magnetic field strength and the force distance dependency of the magnetically controlled growing rods used for early onset scoliosis. Sci Rep 2023; 13:3045. [PMID: 36810891 PMCID: PMC9944223 DOI: 10.1038/s41598-023-30232-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2023] [Accepted: 02/20/2023] [Indexed: 02/23/2023] Open
Abstract
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.
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Matsumoto H, Sinha R, Roye BD, Ball JR, Skaggs KF, Brooks JT, Welborn MC, Emans JB, Anari JB, Johnston CE, Akbarnia BA, Vitale MG, Murphy RF. Contraindications to magnetically controlled growing rods: consensus among experts in treating early onset scoliosis. Spine Deform 2022; 10:1289-1297. [PMID: 35780448 DOI: 10.1007/s43390-022-00543-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2022] [Accepted: 06/06/2022] [Indexed: 10/17/2022]
Abstract
PURPOSE The purpose of this study was to describe contraindications to the magnetically controlled growing rod (MCGR) in patients with early onset scoliosis (EOS) by establishing consensus amongst expert surgeons who treat these patients frequently. METHODS Nine pediatric spine surgeons from an international EOS study group participated in semi-structured interviews via email to identify factors that influence decision making in the use of MCGR. A 39-question survey was then developed to specify these factors as contraindications for MCGR-these included patient age and size, etiology, medical comorbidities, coronal and sagittal curve profiles, and skin and soft tissue characteristics. Pediatric spine surgeons from the EOS international study group were invited to complete the survey. A second 29-item survey was created to determine details and clarify results from the first survey. Responses were analyzed for consensus (> 70%), near consensus (60-69%), and no consensus/variability (< 60%) for MCGR contraindication. RESULTS 56 surgeons of 173 invited (32%) completed the first survey, and 64 (37%) completed the second survey. Responders had a mean of over 15 years in practice (range 1-45) with over 6 years of experience with using MCGR (range 2-12). 71.4% of respondents agreed that patient size characteristics should be considered as contraindications, including BMI (81.3%) and spinal height (84.4%), although a specific BMI range or a specific minimum spinal height were not agreed upon. Among surgeons who agreed that skin and soft tissue problems were contraindications (78.6%), insufficient soft tissue (98%) and skin (89%) to cover MCGR were specified. Among surgeons who reported curve stiffness as a contraindication (85.9%), there was agreement that this curve stiffness should be defined by clinical evaluation (78.2%) and by traction films (72.3%). Among surgeons who reported sagittal curve characteristics as contraindications, hyperkyphosis (95.3%) and sagittal curve apex above T3 (70%) were specified. Surgeons who indicated the need for repetitive MRI as a contraindication (79.7%) agreed that image quality (72.9%) and not patient safety (13.6%) was the concern. In the entire cohort, consensus was not achieved on the following factors: patient age (57.4%), medical comorbidities (46.4%), etiology (53.6%), and coronal curve characteristics (58.9%). CONCLUSION Surgeon consensus suggests that MCGR should be avoided in patients who have insufficient spinal height to accommodate the MCGR, have potential skin and soft tissue inadequacy, have too stiff a spinal curve, have too much kyphosis, and require repetitive MRI, particularly of the spine. Future data-driven studies using this framework are warranted to generate more specific criteria (e.g. specific degrees of kyphosis) to facilitate clinical decision making for EOS patients. LEVEL OF EVIDENCE Level V-expert opinion.
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Affiliation(s)
- Hiroko Matsumoto
- Department of Orthopedic Surgery, Columbia University Irving Medical Center, New York, NY, 10032, USA.
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, 10032, USA.
| | - Rishi Sinha
- Department of Orthopedic Surgery, Columbia University Irving Medical Center, New York, NY, 10032, USA
| | - Benjamin D Roye
- Department of Orthopedic Surgery, Columbia University Irving Medical Center, New York, NY, 10032, USA
- Division of Pediatric Orthopaedic Surgery, New York-Presbyterian Morgan Stanley Children's Hospital, Columbia University Irving Medical Center, New York, NY, 10032, USA
| | - Jacob R Ball
- Department of Orthopedic Surgery, Columbia University Irving Medical Center, New York, NY, 10032, USA
| | - Kira F Skaggs
- Department of Orthopedic Surgery, Columbia University Irving Medical Center, New York, NY, 10032, USA
| | - Jaysson T Brooks
- Scottish Rite for Children/UT-Southwestern, Dallas, TX, 75219, USA
| | - Michelle C Welborn
- Department of Orthopaedic Surgery, Shriner's Hospital for Children Portland, Portland, OR, 97229, USA
| | - John B Emans
- Department of Orthopedic Surgery, Boston Children's Hospital, Boston, MA, 02115, USA
| | - Jason B Anari
- Division of Orthopaedics, Children's Hospital of Philadelphia, Philadelphia, PA, 19104, USA
| | | | - Behrooz A Akbarnia
- San Diego Spine Foundation, San Diego, CA, 92121, USA
- Department of Orthopaedic Surgery, University of California San Diego School of Medicine, La Jolla, CA, 92093, USA
| | - Michael G Vitale
- Department of Orthopedic Surgery, Columbia University Irving Medical Center, New York, NY, 10032, USA
- Division of Pediatric Orthopaedic Surgery, New York-Presbyterian Morgan Stanley Children's Hospital, Columbia University Irving Medical Center, New York, NY, 10032, USA
| | - Robert F Murphy
- Department of Orthopaedics, Medical University of South Carolina, Charleston, SC, 29492, USA
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Liu Z, Gao K, Hai Y, Liu T. Developments, Focuses, and Trends in Early-Onset Scoliosis From 2005 to 2020: A Systematic Bibliometric Analysis. World Neurosurg 2021; 158:e697-e710. [PMID: 34798338 DOI: 10.1016/j.wneu.2021.11.044] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2021] [Revised: 11/09/2021] [Accepted: 11/10/2021] [Indexed: 12/13/2022]
Abstract
OBJECTIVE Although several studies have been reported on early-onset scoliosis (EOS), a bibliometric analysis is still lacking. A systematic bibliometric analysis will enable researchers to understand the scope of the research topics, identify research focuses and key literature, and predict future research directions. METHODS Literature data were retrieved from the Web of Science Core Collection database. The Web of Science Results Analysis and Citation Report were used to analyze the reported studies in different views. CiteSpace and VOSviewer were used for further analysis, including a cooperation network analysis of the authors, institutions, countries and/or regions, discipline and journal analysis, reference co-citation analysis, and keyword co-occurrence analysis. RESULTS The final analysis included 674 relevant studies reported from 2005 to 2020. During the study period, the field of EOS has expanded rapidly. Multiple cooperation was found among the authors, institutions, and countries and/or regions, with some making great contributions. The results of the reference co-citation analysis showed that the studies had several main focuses, including the growing rod (GR), magnetically controlled GR, an EOS 24-item questionnaire, and a growth evaluation. CONCLUSIONS From 2005 to 2020, surgical treatment has remained the focus of research in the EOS field. The magnetically controlled GR is the latest research focus, which might become more comprehensive in the future. The Gr has remained the most popular topic, and potential new surgical techniques might require improvement to become the favored techniques. In addition, assessing the health-related quality of life and growth parameters of patients with EOS have become a popular topic.
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Affiliation(s)
- Ziyang Liu
- Department of Orthopedic Surgery, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
| | - Kang Gao
- Dental Implant Center, Beijing Stomatological Hospital, Capital Medical University, Beijing, China
| | - Yong Hai
- Department of Orthopedic Surgery, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China.
| | - Tie Liu
- Department of Orthopedic Surgery, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
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