Staged instrumentation with magnetically controlled growing rods in early-onset scoliosis: indications and preliminary outcomes.

Background: Severe scoliosis, kyphosis, stiffer curves, short trunk height, and poor bone density are known risk factors for instrumentation failure with traditional growing rods or magnetically controlled growing rods (MCGR). To minimize the risk of instrumentation failure in managing complex early-onset scoliosis (EOS) with MCGR, we propose a strategy for staged MCGR insertion.

Methods: We performed a single-center retrospective review of all consecutive MCGR cases with 24 months' minimum follow-up. Inclusion criteria included diagnosis of EOS of any etiology with severe and stiff curves in the coronal or sagittal planes, poor bone density, short trunk height (T1-T12 smaller than 150 mm) or previous instrumentation failure managed with staged MCGR. During the first stage, anchor points and halo-gravity were applied, followed by halo-gravity traction. At a second stage, halo-gravity was removed and MCGR were inserted. Outcome measures included pre- and postoperative radiographic measurements and complications.

Results: Seventeen patients with a median age of 7 (range 6-9) years were managed in two stages. Indications for two-stage surgery were short trunk height (T1-T12 height less than 150 mm) in six patients, five poor bone quality, three dislodgement of proximal anchor points in previous instrumentation, and three rigid curves. The rate of unplanned revision surgeries was 11.8%. No infections or traction-related complications were found.

Conclusions: According to our results, the staged MCGR insertion strategy combined with halo-gravity traction to manage complex EOS yielded a relatively low instrumentation failure rate as compared with the rates previously reported in the current literature. To our knowledge, this is the first study reporting the staged strategy for instrumentation with MCGR.

Level Of Evidence: IV.