Implant Complications After Magnetically Controlled Growing Rods for Early Onset Scoliosis: A Multicenter Retrospective Review

Edmund Choi, Burt Yazsay, Gregory Mundis, Pooria Hosseini, Jeff Pawelek, Ahmet Alanay, Haluk Berk, Kenneth Cheung, Gokhan Demirkiran, John Ferguson, Tiziana Greggi, Ilkka Helenius, Guido La Rosa, Alpaslan Senkoylu, Behrooz A. Akbarnia

Research output: Contribution to journalArticle

Abstract

BACKGROUND: Traditional growing rods have a reported wound and implant complication rate as high as 58%. It is unclear whether the use of magnetically controlled growing rods (MCGR) will affect this rate. This study was performed to characterize surgical complications following MCGR in early onset scoliosis.

METHODS: A multicenter retrospective review of MCGR cases was performed. Inclusion criteria were: (1) diagnosis of early onset scoliosis of any etiology; (2) 10 years and younger at time of index surgery; (3) preoperative major curve size >30 degrees; (4) preoperative thoracic spine height <22 cm. Complications were categorized as wound related and instrumentation related. Complications were also classified as early (<6 mo from index surgery) versus late (>6 mo). Distraction technique and interval of distraction was surgeon preference without standardization across sites.

RESULTS: Fifty-four MCGR patients met inclusion criteria. There were 30 primary and 24 conversion procedures. Mean age at initial surgery was 7.3 years (range, 2.4 to 11 y), and mean duration of follow-up 19.4 months. Twenty-one (38.8%) of 54 patients had at least 1 complication. Fifteen (27.8%) had at least 1 revision surgery. Six (11.1%) had broken rods (2 to 4.5 and 4 to 5.5 mm rods); two 5.5 mm rods failed early (4 mo) and 4 late (mean=14.5 mo). Six (11.1%) patients experienced 1 episode of lack or loss of lengthening, of which 4 patients subsequently lengthened. Seven patients (13.0%) had either proximal or distal fixation-related complication at average of 8.4 months. Two patients (3.7%) had infections requiring incision and drainage; 1 early (2 wk) with wound drainage and 1 late (8 mo). The late case required removal of one of the dual rods.

CONCLUSIONS: This study shows that compared with traditional growing rods, MCGR has a lower infection rate (3.7% vs. 11.1%). MCGR does not appear to prevent common implant-related complications such as rod or foundation failure. The long-term implication remains to be determined.

LEVEL OF EVIDENCE: Level IV.

Original languageEnglish
JournalJournal of Pediatric Orthopaedics
DOIs
Publication statusE-pub ahead of print - Jun 18 2016

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Scoliosis
Drainage
Wounds and Injuries
Infection
Reoperation
Spine
Thorax

Keywords

  • Journal Article

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Implant Complications After Magnetically Controlled Growing Rods for Early Onset Scoliosis : A Multicenter Retrospective Review. / Choi, Edmund; Yazsay, Burt; Mundis, Gregory; Hosseini, Pooria; Pawelek, Jeff; Alanay, Ahmet; Berk, Haluk; Cheung, Kenneth; Demirkiran, Gokhan; Ferguson, John; Greggi, Tiziana; Helenius, Ilkka; La Rosa, Guido; Senkoylu, Alpaslan; Akbarnia, Behrooz A.

In: Journal of Pediatric Orthopaedics, 18.06.2016.

Research output: Contribution to journalArticle

Choi, E, Yazsay, B, Mundis, G, Hosseini, P, Pawelek, J, Alanay, A, Berk, H, Cheung, K, Demirkiran, G, Ferguson, J, Greggi, T, Helenius, I, La Rosa, G, Senkoylu, A & Akbarnia, BA 2016, 'Implant Complications After Magnetically Controlled Growing Rods for Early Onset Scoliosis: A Multicenter Retrospective Review', Journal of Pediatric Orthopaedics. https://doi.org/10.1097/BPO.0000000000000803
Choi, Edmund ; Yazsay, Burt ; Mundis, Gregory ; Hosseini, Pooria ; Pawelek, Jeff ; Alanay, Ahmet ; Berk, Haluk ; Cheung, Kenneth ; Demirkiran, Gokhan ; Ferguson, John ; Greggi, Tiziana ; Helenius, Ilkka ; La Rosa, Guido ; Senkoylu, Alpaslan ; Akbarnia, Behrooz A. / Implant Complications After Magnetically Controlled Growing Rods for Early Onset Scoliosis : A Multicenter Retrospective Review. In: Journal of Pediatric Orthopaedics. 2016.
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title = "Implant Complications After Magnetically Controlled Growing Rods for Early Onset Scoliosis: A Multicenter Retrospective Review",
abstract = "BACKGROUND: Traditional growing rods have a reported wound and implant complication rate as high as 58{\%}. It is unclear whether the use of magnetically controlled growing rods (MCGR) will affect this rate. This study was performed to characterize surgical complications following MCGR in early onset scoliosis.METHODS: A multicenter retrospective review of MCGR cases was performed. Inclusion criteria were: (1) diagnosis of early onset scoliosis of any etiology; (2) 10 years and younger at time of index surgery; (3) preoperative major curve size >30 degrees; (4) preoperative thoracic spine height <22 cm. Complications were categorized as wound related and instrumentation related. Complications were also classified as early (<6 mo from index surgery) versus late (>6 mo). Distraction technique and interval of distraction was surgeon preference without standardization across sites.RESULTS: Fifty-four MCGR patients met inclusion criteria. There were 30 primary and 24 conversion procedures. Mean age at initial surgery was 7.3 years (range, 2.4 to 11 y), and mean duration of follow-up 19.4 months. Twenty-one (38.8{\%}) of 54 patients had at least 1 complication. Fifteen (27.8{\%}) had at least 1 revision surgery. Six (11.1{\%}) had broken rods (2 to 4.5 and 4 to 5.5 mm rods); two 5.5 mm rods failed early (4 mo) and 4 late (mean=14.5 mo). Six (11.1{\%}) patients experienced 1 episode of lack or loss of lengthening, of which 4 patients subsequently lengthened. Seven patients (13.0{\%}) had either proximal or distal fixation-related complication at average of 8.4 months. Two patients (3.7{\%}) had infections requiring incision and drainage; 1 early (2 wk) with wound drainage and 1 late (8 mo). The late case required removal of one of the dual rods.CONCLUSIONS: This study shows that compared with traditional growing rods, MCGR has a lower infection rate (3.7{\%} vs. 11.1{\%}). MCGR does not appear to prevent common implant-related complications such as rod or foundation failure. The long-term implication remains to be determined.LEVEL OF EVIDENCE: Level IV.",
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T1 - Implant Complications After Magnetically Controlled Growing Rods for Early Onset Scoliosis

T2 - A Multicenter Retrospective Review

AU - Choi, Edmund

AU - Yazsay, Burt

AU - Mundis, Gregory

AU - Hosseini, Pooria

AU - Pawelek, Jeff

AU - Alanay, Ahmet

AU - Berk, Haluk

AU - Cheung, Kenneth

AU - Demirkiran, Gokhan

AU - Ferguson, John

AU - Greggi, Tiziana

AU - Helenius, Ilkka

AU - La Rosa, Guido

AU - Senkoylu, Alpaslan

AU - Akbarnia, Behrooz A.

PY - 2016/6/18

Y1 - 2016/6/18

N2 - BACKGROUND: Traditional growing rods have a reported wound and implant complication rate as high as 58%. It is unclear whether the use of magnetically controlled growing rods (MCGR) will affect this rate. This study was performed to characterize surgical complications following MCGR in early onset scoliosis.METHODS: A multicenter retrospective review of MCGR cases was performed. Inclusion criteria were: (1) diagnosis of early onset scoliosis of any etiology; (2) 10 years and younger at time of index surgery; (3) preoperative major curve size >30 degrees; (4) preoperative thoracic spine height <22 cm. Complications were categorized as wound related and instrumentation related. Complications were also classified as early (<6 mo from index surgery) versus late (>6 mo). Distraction technique and interval of distraction was surgeon preference without standardization across sites.RESULTS: Fifty-four MCGR patients met inclusion criteria. There were 30 primary and 24 conversion procedures. Mean age at initial surgery was 7.3 years (range, 2.4 to 11 y), and mean duration of follow-up 19.4 months. Twenty-one (38.8%) of 54 patients had at least 1 complication. Fifteen (27.8%) had at least 1 revision surgery. Six (11.1%) had broken rods (2 to 4.5 and 4 to 5.5 mm rods); two 5.5 mm rods failed early (4 mo) and 4 late (mean=14.5 mo). Six (11.1%) patients experienced 1 episode of lack or loss of lengthening, of which 4 patients subsequently lengthened. Seven patients (13.0%) had either proximal or distal fixation-related complication at average of 8.4 months. Two patients (3.7%) had infections requiring incision and drainage; 1 early (2 wk) with wound drainage and 1 late (8 mo). The late case required removal of one of the dual rods.CONCLUSIONS: This study shows that compared with traditional growing rods, MCGR has a lower infection rate (3.7% vs. 11.1%). MCGR does not appear to prevent common implant-related complications such as rod or foundation failure. The long-term implication remains to be determined.LEVEL OF EVIDENCE: Level IV.

AB - BACKGROUND: Traditional growing rods have a reported wound and implant complication rate as high as 58%. It is unclear whether the use of magnetically controlled growing rods (MCGR) will affect this rate. This study was performed to characterize surgical complications following MCGR in early onset scoliosis.METHODS: A multicenter retrospective review of MCGR cases was performed. Inclusion criteria were: (1) diagnosis of early onset scoliosis of any etiology; (2) 10 years and younger at time of index surgery; (3) preoperative major curve size >30 degrees; (4) preoperative thoracic spine height <22 cm. Complications were categorized as wound related and instrumentation related. Complications were also classified as early (<6 mo from index surgery) versus late (>6 mo). Distraction technique and interval of distraction was surgeon preference without standardization across sites.RESULTS: Fifty-four MCGR patients met inclusion criteria. There were 30 primary and 24 conversion procedures. Mean age at initial surgery was 7.3 years (range, 2.4 to 11 y), and mean duration of follow-up 19.4 months. Twenty-one (38.8%) of 54 patients had at least 1 complication. Fifteen (27.8%) had at least 1 revision surgery. Six (11.1%) had broken rods (2 to 4.5 and 4 to 5.5 mm rods); two 5.5 mm rods failed early (4 mo) and 4 late (mean=14.5 mo). Six (11.1%) patients experienced 1 episode of lack or loss of lengthening, of which 4 patients subsequently lengthened. Seven patients (13.0%) had either proximal or distal fixation-related complication at average of 8.4 months. Two patients (3.7%) had infections requiring incision and drainage; 1 early (2 wk) with wound drainage and 1 late (8 mo). The late case required removal of one of the dual rods.CONCLUSIONS: This study shows that compared with traditional growing rods, MCGR has a lower infection rate (3.7% vs. 11.1%). MCGR does not appear to prevent common implant-related complications such as rod or foundation failure. The long-term implication remains to be determined.LEVEL OF EVIDENCE: Level IV.

KW - Journal Article

U2 - 10.1097/BPO.0000000000000803

DO - 10.1097/BPO.0000000000000803

M3 - Article

C2 - 27328123

JO - Journal of Pediatric Orthopaedics

JF - Journal of Pediatric Orthopaedics

SN - 0271-6798

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