Increasing soft tissue depth is associated with stalling of magnetically controlled growing rods

K Aaron Shaw; Adam Jamnik; Anna McClung; David Thornberg; Brandon Ramo; Amy McIntosh

doi:10.1016/j.xnsj.2023.100230

Increasing soft tissue depth is associated with stalling of magnetically controlled growing rods

N Am Spine Soc J. 2023 May 16:14:100230. doi: 10.1016/j.xnsj.2023.100230. eCollection 2023 Jun.

Authors

K Aaron Shaw¹, Adam Jamnik¹, Anna McClung¹, David Thornberg¹, Brandon Ramo¹, Amy McIntosh¹

Affiliation

¹ Department of Pediatric Orthopedic Surgery, Scottish Rite for Children Hospital, 2222 Welborn St, Dallas, TX, USA.

Abstract

Background: Magnetically controlled growing rods (MCGR) represent the most used implant for the treatment of early onset scoliosis (EOS). These implants lengthen through the application of a remote magnetic field but distraction force generation has been negatively correlated with increasing soft tissue depth. Given the high rate of MCGR stalling, we proposed to investigate the impact of preoperative soft tissue depth on the rate of MCGR stalling at a minimum of 2 years following implantation.

Methods: A single-center, retrospective review of prospectively enrolled children with EOS treated with MCGR was performed. Children were included if they had a minimum of 2-years follow-up after implantation and underwent advanced spinal imaging (MRI or CT) preoperatively within a year of implantation. The primary outcome was the development of MCGR stall. Additional measures included radiographic deformity parameters and gain in MCGR actuator length.

Results: About 55 patients were identified with 18 having preoperative advanced imaging allowing tissue depth measurement (Mean 5.99 ± 1.9 years, 83.3% female, mean Cobb 68.6 ± 13.8°). At a mean follow-up of 46.1 ± 11.9 months, 7 patients (38.9%) experienced stalling. MCGR stalling was associated with increased preoperative soft tissue depth (21.5 ± 4.4 mm vs. 16.5 ± 4.1 mm; p = .025) and increased BMI (16.3 ± 1.6 vs. 14.5 ± 0.9; p = .007).

Conclusions: Greater preoperative soft tissue depth and BMI were associated with the development of MCGR stalling. This data supports previous studies showing that the distraction capacity of MCGR diminishes with increased soft tissue depth. Further research is needed to validate these findings and their implications on the indications for MCGR implantation.

Keywords: Distraction failure; Early onset scoliosis; Magnetically-controlled growing rods; Soft tissue depth; Stall.