Introduction

Early Onset Scoliosis (EOS), a debilitating spinal deformity affecting children under ten years of age, presents significant challenges in clinical management, given the concomitant need for allowing spinal growth and deformity correction. The introduction of magnetically controlled growing rods (MCGR) has revolutionized the treatment, offering the possibility of non-invasive lengthening procedures. A recent retrospective review, carried out by a group of prominent researchers, aimed to evaluate the health-related quality of life (HRQoL) and clinical outcomes for EOS patients treated with MCGR and followed to definitive fusion (DF).

Methods and Materials

The study, as published on January 14, 2024, in the journal Spine Deformity (DOI: 10.1007/s43390-023-00801-y), was conducted by a team including Adam A. Jamnik, K. Aaron Shaw, David Thornberg, Anna McClung, Chan-Hee Jo, Brandon Ramo, and Amy McIntosh from various respected institutions such as the University of Texas Southwestern Medical Center and Scottish Rite for Children. The authors performed a rigorous retrospective analysis on 28 patients who underwent MCGR treatment and followed them to their eventual DF. They assessed HRQoL scores, radiographic data, clinical outcomes, and the frequency of unplanned returns to the operating room (UPROR).

Findings

The study included 28 patients (57.1% female) with a mean age at MCGR insertion of 7.19 ± 1.5 years and a mean pre-MCGR Cobb angle of 64.7° ± 17.6. Post-treatment with MCGR and subsequent DF, the patients showed an overall 30.2% improvement in coronal plane deformity. Notably, the spinal growth rates (T1-T12 height and T1-S1 length) measured from MCGR implantation until pre-DF stood at an average of 0.33 ± 0.23 mm/month and 0.49 ± 0.28 mm/month, respectively.

Complications

The research revealed that the journey to DF was fraught with challenges. Approximately 92.9% of the participants experienced at least one UPROR, signaling a high rate of surgical complications. In total, 52 complications occurred across the cohort, averaging 1.9 UPROR per patient. Despite these complications, the study highlighted that HRQoL scores remained stable when comparing pre-MCGR implantation and post-DF scores.

Discussion

This evidence suggests that while MCGR treatment effectively manages deformity and supports spinal growth, the road to DF is complicated, substantiating the need for improved strategies to minimize UPROR. Still, it’s encouraging to note that patients maintained consistent HRQoL outcomes, an essential aspect of holistic patient care.

Implications for Practice

The findings from this study offer valuable insights for pediatric orthopedic surgeons and healthcare providers managing EOS. It underscores the importance of a shared decision-making process with patients and families, considering the potential for complications and the impact on quality of life.

Conclusion

In conclusion, this retrospective review is a significant contribution to the literature on EOS and MCGR treatment. Though MCGR is a groundbreaking treatment modality with the potential to improve the spine’s coronal plane deformity and support growth, it is not devoid of challenges. The study’s outcomes emphasize the need for a personalized approach considering HRQoL and the possibility of complications.

References

1. Guzek RH, Murphy R, Hardesty CK, et al. (2022). Mortality in early-onset scoliosis during the growth-friendly surgery era. J Pediatr Orthop, 42, 131–137. DOI: 10.1097/BPO.0000000000001983
2. El-Hawary R, Akbarnia BA. (2015). Early onset scoliosis—time for consensus. Spine Deformity, 3, 105–106. DOI: 10.1016/j.jspd.2015.01.003
3. Skaggs DL, Akbarnia BA, Flynn JM, et al. (2014). A classification of growth friendly spine implants. J Pediatr Orthop, 34, 260–274. DOI: 10.1097/BPO.0000000000000073
4. Migliorini F, Chiu WO, Scrofani R, et al. (2022). Magnetically controlled growing rods in the management of early onset scoliosis: a systematic review. J Orthop Surg Res, 17, 309. DOI: 10.1186/s13018-022-03200-7
5. Akbarnia BA, Pawelek JB, Cheung KMC, et al. (2014). Traditional growing rods versus magnetically controlled growing rods for the surgical treatment of early-onset scoliosis: a case-matched 2-year study. Spine Deform, 2, 493–497. DOI: 10.1016/j.jspd.2014.09.050

Keywords

1. Magnetically Controlled Growing Rods
2. Early Onset Scoliosis Treatment
3. Spinal Deformity Correction
4. Health-Related Quality of Life in EOS
5. Post-Definitive Fusion Outcomes

The comprehensive article is an in-depth discussion surrounding the clinical outcomes of magnetically controlled growing rod patients in early onset scoliosis, stressing the importance of evaluating both the therapeutic efficacy and considering the patient’s quality of life. This insight could lead to enhanced strategies in managing and improving the lives of children with this condition.