Graduation Protocol After Growing-Rod Treatment: Removal of Implants without New Instrumentation Is Not a Realistic Approach

Kocyigit, Ismail Aykut; Olgun, Z. Deniz; Demirkiran, H. Gokhan; Ayvaz, Mehmet; Yazıcı, Muharrem

doi:10.2106/jbjs.17.00031

Cited by 34 publications

(33 citation statements)

References 11 publications

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“…5,6 In 2017 Kocyigit et al 3 mentioned a comparative study in patients treated with growing rods, and they concluded that in patients who achieved skeletal maturity, rod removal without new instrumentation is an unacceptable treatment because it leads to a worsening of the deformity. The results in the 2 presented cases confirm the conclusions of Kocygit et al 3 Despite observing, after the rods' removal, an acceptable and satisfying final correction (508), skeletal maturity (Risser 5), and the appearance of secondary sexual characteristics, we also observed a rapid progression of the deformity. Because of this experience, some observations are needed.…”

Section: Discussionsupporting

confidence: 90%

“…EOS treatment with Magec rods has been established, but patient management at the end of the lengthening period, until skeletal maturity, remains controversial. In the literature, the reported options 3 are the rods' removal followed by patient observation, rods' removal and immediate instrumented fusion, or rod maintenance/replacement. We present 2 cases of EOS patients treated with Magec rods (NuVasive Specialized Orthopedics Inc, Aliso Viejo, CA) up to skeletal maturity.…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Idiopathic Early-Onset Scoliosis Treated With Magec Rods: What to Do After the Lengthening Period Is Over?

Balsano

Spina

2020

Int J Spine Surg

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The treatment of early-onset scoliosis with magnetic growing rods has been established, but the management at the end of the lengthening program is still controversial. The options available are removal of rods and observation, removal of rods and immediate fusion, or replacement/maintenance of rods. We present 2 cases of early-onset scoliosis patients treated with Magec rods, up to skeletal maturity. In the first case of a Lenke 3 scoliosis (14 years and 11 months) with a thoracic curve of 508 and lumbar curve of 408, we removed the rods and kept the patient under observation. After 5 months, the patient showed curve progression, with a thoracic curve of 618 and a lumbar curve of 578. Consequently, we performed an instrumented T4 to L4 fusion with a correction of the thoracic curve of 66% and lumbar curve of 60%. In the second case of a Lenke 1 scoliosis (15 years and 10 months) with a thoracic curve of 388, the rods were removed and the patient was kept under observation. After 10 months, following a curve progression, presenting a thoracic curve of 728, we performed an instrumented fusion T5 to L2 and right thoracoplasty (6 th to 11 th ribs) with a 40% curve correction. Observing these 2 cases at the end of the treatment with Magec rods, even in case of a good and satisfying final correction, skeletal maturity, and secondary sexual characteristics, we recommend immediate instrumented spine fusion.

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Section: Discussionsupporting

confidence: 90%

Section: Introductionmentioning

confidence: 99%

Idiopathic Early-Onset Scoliosis Treated With Magec Rods: What to Do After the Lengthening Period Is Over?

Balsano

Spina

2020

Int J Spine Surg

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“…In this context, Kocyigit et al ask the important question of whether avoiding final fusion can be taken a step further with the removal of growing rods [12]. The authors hypothesize that autofusion results in enough stability to prevent further curve progression.…”

Section: Commentarymentioning

confidence: 99%

“…Given the numerous challenges of management at the conclusion of growing rod treatment, authors of a recent study examine the option of removing the growing rods without subsequent fusion. This article describes a single-center prospective cohort study of 26 children who underwent growing rod treatment when they were 10 years old or younger [12]. The authors used an institutional database to identify 86 patients with traditional growing rods.…”

Section: Introductionmentioning

confidence: 99%

In Patients with Early-Onset Scoliosis, Can Growing Rods Be Removed without Further Instrumentation? An Evidenced-Based Review

Shen

Schairer

Widmann

2019

HSS Journal®: The Musculoskeletal Journal of Hospital for Speci

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Early-onset scoliosis (EOS) is defined by the presence of spinal deformity in children 10 years of age or younger. Left untreated, patients with EOS are at high risk for thoracic insufficiency and early demise. This article provides a critical review of a recent prospective cohort study of children with EOS: BGraduation Protocol After Growing-Rod Treatment: Removal of Implants without New Instrumentation Is Not a Realistic Approach,^by Kocyigit and colleagues (J Bone Joint Surg Am. 2017;99(18):1554-1564). Treatment for EOS requires deformity correction while accommodating the growing spine. Dual growing rod implantation is a welldescribed technique that consists of the placement of two telescoping rods anchored to vertebrae proximal and distal to the apex of the curve. Multiple lengthening procedures are then performed as the child grows. Management of the endpoint of growing rod treatment remains controversial, with high complication rates associated with final fusion. As an alternative to final fusion or implant retention, Kocyigit and colleagues examined the removal of growing rods without spinal fusion and found that this procedure resulted in substantial worsening of the deformity in nine out of ten patients. This treatment group was terminated on ethical grounds. We believe this important result demonstrates that the removal of implants without fusion is an unacceptable treatment strategy that leads to poor outcomes.

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“…For TGRs, one study suggested that only 38% (10/26) patients at skeletal maturity are suitable for implant removal without spinal fusion. 71 However, nine of these patients had progression of the deformity after implant removal resulting in an additional surgery for fusion. Whether patients can or should remove their MCGRs without fusion or whether every patient needs final fusion should be studied.…”

Section: Moving Forwardsmentioning

confidence: 99%

Current status of the magnetically controlled growing rod in treatment of early-onset scoliosis: What we know after a decade of experience

Cheung

2019

J Orthop Surg (Hong Kong)

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The magnetically controlled growing rod (MCGR) has had approximately 10 years of clinical experience worldwide. Clinical effectiveness to control early-onset scoliosis is consistent even at final surgery. MCGRs have significantly lower relative percentage of infection or wound complications as compared to traditional growing rods. Most common complications include foundation failure and failure of distraction. Contouring of the rod especially at the proximal segment while accommodating for the straight actuator remains a difficult task and its failure may lead to proximal junctional kyphosis. Unique complications of MCGR include clunking, temporary diminishing distraction gains, and metallosis. Temporary reductions in distraction gains are observed as the MCGR lengthens but return to normal baseline distraction gains after rod exchange. Lack of standardization for rod configuration, distraction strategies and decisions of whether to keep the rods in situ, remove without fusion surgery or to perform spinal fusion at skeletal maturity will require further study.

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Graduation Protocol After Growing-Rod Treatment: Removal of Implants without New Instrumentation Is Not a Realistic Approach

Abstract: Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.

Cited by 34 publications

References 11 publications

Idiopathic Early-Onset Scoliosis Treated With Magec Rods: What to Do After the Lengthening Period Is Over?

Idiopathic Early-Onset Scoliosis Treated With Magec Rods: What to Do After the Lengthening Period Is Over?

In Patients with Early-Onset Scoliosis, Can Growing Rods Be Removed without Further Instrumentation? An Evidenced-Based Review

Current status of the magnetically controlled growing rod in treatment of early-onset scoliosis: What we know after a decade of experience

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