학술논문
Lengthening Behavior of Magnetically Controlled Growing Rods in Early-Onset Scoliosis: A Multicenter Study
Document Type
Academic Journal
Author
Heyer, Jessica H.; Anari, Jason B.; Baldwin, Keith D.; Mitchell, Stuart L.; Luhmann, Scott J.; Sturm, Peter F.; Flynn, John M.; Cahill, Patrick J.; Abdulfattah Abdullah, Abdullah Saad; Ahn, Edward; Akbarnia, Behrooz; Akoto, Harry; Albanese, Stephen; Anari, Jason; Anderson, John; Anderson, Richard; Andras, Lindsay; Bauer, Jennifer; Bellaire, Laura; Betz, Randy; Birch, Craig; Blakemore, Laurel; Boachie-Adjei, Oheneba; Bonfield, Chris; Bouton, Daniel; Brassard, Felix; Brockmeyer, Douglas; Brooks, Jaysson; Bumpass, David; Cahill, Pat; Chemaly, Olivier; Cheung, Jason; Cheung, Kenneth; Cho, Robert; Christman, Tyler; Beauchamp, Eduardo Colom; Couture, Daniel; Crawford, Haemish; Crawford, Alvin; Dahl, Benny; Demirkiran, Gokhan; Devito, Dennis; Diab, Mohammad; El Sebaie, Hazem; El-Hawary, Ron; Emans, John; Erickson, Mark; Fabregas, Jorge; Farley, Frances; Farrington, David; Fedorak, Graham; Fitzgerald, Ryan; Fletcher, Nicholas; Floccari, Lorena; Flynn, Jack; Gabos, Peter; Gardner, Adrian; Garg, Sumeet; Gerow, Frank; Glotzbecker, Michael; Gomez, Jaime; Gonda, David; Guillaume, Tenner; Gupta, Purnendu; Halvorson, Kyle; Hammerberg, Kim; Hardesty, Christina; Hedequist, Daniel; Heffernan, Michael; Heflin, John; Helenius, Ilkka; Herrera, Jose; Hogue, Grant; Holt, Josh; Howard, Jason; Hresko, Michael Timothy; Hwang, Steven; Ihnow, Stephanie; Ilharreborde, Brice; Illingworth, Kenneth; Jain, Viral; Jea, Andrew; Johnson, Megan; Johnston, Charles; Jones, Morgan; Karlen, Judson; Karlin, Lawrence; Katz, Danielle; Kawakami, Noriaki; Kelly, Brian; Kelly, Derek; Knapp, Raymond; Koljonen, Paul; Kwan, Kenny; Labelle, Hubert; Lark, Robert; Larson, A. Noelle; Lavelle, William; Lenke, Lawrence; Lew, Sean; Li, Gertrude; Louer, Craig; Luhmann, Scott; Mac-Thiong, Jean-Marc; Mackenzie, Stuart; MacKintosh, Erin; Mangano, Francesco; Marks, David; Marquez, Sanchez; Martin, Jonathan; Martus, Jeffrey; Matamalas, Antonia; Mayer, Oscar; McCarthy, Richard; McIntosh, Amy; McQuerry, Jessica; Mehta, Jwalant; Metz, Lionel; Miller, Daniel; Miyanji, Firoz; Mundis, Greg; Murphy, Josh; Murphy, Robert; Myung, Karen; Nelson, Susan; Newton, Peter; Ede, Matthew Newton; Nguyen, Cynthia; Nunez, Susana; Oetgen, Matthew; Oswald, Timothy; Ouellet, Jean; Pahys, Josh; Palomino, Kathryn; Parent, Stefan; Garcia, Alejandro Peiro; Pellise, Ferran; Perra, Joseph; Phillips, Jonathan; Pizones, Javier; Poon, Selina; Price, Nigel; Ramirez-Lluch, Norman; Ramo, Brandon; Redding, Gregory; Ritzman, Todd; Rodriguez, Luis; Rodriguez-Olaverri, Juan Carlos; Roye, David; Roye, Benjamin; Saiman, Lisa; Samdani, Amer; Perez-Grueso, Francisco Sanchez; Sanders, James; Sawyer, Jeffrey; Sayama, Christina; Schmitz, Michael; Schulz, Jacob; Schwend, Richard; Shah, Suken; Shapiro, Jay; Shufflebarger, Harry; Skaggs, David; Smit, Kevin; Smith, John; Snyder, Brian; Sponseller, Paul; Stephen, George; Stone, Joe; Sturm, Peter; Sukkarieh, Hamdi; Swarup, Ishaan; Szczodry, Michal; Thometz, John; Thompson, George; Tomoko, Tanaka; Truong, Walter; Vialle, Raphael; Vitale, Michael; Vorhies, John; Wall, Eric; Wang, Shengru; Warner, Bill; Weinstein, Stuart; Welborn, Michelle; White, Klane; Wrubel, David; Wu, Nan; Yankey, Kwadwo; Yaszay, Burt; Yazici, Muharrem; Zhang, Terry Jianguo
Source
The Journal of Bone and Joint Surgery. Dec 21, 2022 104(24):2186-2194
Subject
Language
English
ISSN
0021-9355
Abstract
BACKGROUND:: The “law of diminishing returns” is described for traditional growing rods. Magnetically controlled growing rods (MCGRs) have become a preferred implant for the surgical treatment of early-onset scoliosis (EOS). We examined a large cohort of patients with EOS to determine whether the law of diminishing returns applies to MCGRs. METHODS:: A prospectively collected, multicenter registry was queried for patients with EOS treated with MCGRs. Patients with only spine-based implants and a minimum of 2 years of follow-up were included; patients with congenital scoliosis, single rods, <3 lengthenings, or >25% missing data were excluded. Patients were analyzed in 3 cohorts: primary MCGR (pMCGR) had first-time MCGR implants, secondary MCGR (sMCGR) were converted from an MCGR to a new MCGR, and conversion MCGR (cMCGR) were converted from a non-MCGR implant to MCGR. RESULTS:: A total of 189 patients in the pMCGR group, 44 in the cMCGR group, and 41 in the sMCGR group were analyzed. From post-MCGR placement to the most recent follow-up or pre-definitive procedure, there were no differences in the changes in major Cobb angle, T1-S1 height, or T1-T12 height over time between the pMCGR and cMCGR groups. There was a decrease in length achieved at subsequent lengthenings in all cohorts (p < 0.01), and the sMCGR group had a significantly poorer ability to lengthen at each subsequent lengthening versus the pMCGR and cMCGR groups (p < 0.02). The 1-year survival rate was 90.5% for pMCGR, 84.1% for sMCGR, and 76.4% for cMCGR; 2-year survival was 61.5%, 54.4%, and 41.4%, respectively; and 3-year survival was 37.6%, 36.7%, and 26.9%, respectively. Excluding MCGRs still expanding, 27.6% of pMCGRs, 8.8% of sMCGRs, and 17.1% of cMCGRs reached the maximum excursion. Overall, 21.7% reached the maximum excursion. Within the pMCGR cohort, idiopathic and neuromuscular etiologies had a decline in lengthening achieved over time (p < 0.001), while syndromic EOS demonstrated a preserved ability to lengthen over time (p = 0.51). When the etiological groups were compared with each other, the neuromuscular group had the least ability to lengthen over time (p = 0.001 versus syndromic, p = 0.02 versus idiopathic). CONCLUSIONS:: The MCGR experiences the law of diminishing returns in patients with EOS. We found that only 21.7% of rods expanded to within 80% of the maximum excursion. LEVEL OF EVIDENCE:: Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.