Followed by conversion to Growth Guidance Surgery
6-26-2024
This case is a continuation of the last post in which a very young male was treated with a unilateral MAGEC rod. In that post the case ended at 3 years after placement of the MAGEC rod with it being maximally lengthened. He is now 6 years of age and is much taller, and is thriving.
How do we proceed with treating his scoliosis, now that the MAGEC growing rod has been maximally lengthened?
Remember some key basic goals of treatment of early-onset scoliosis are:
- 3-dimensional correction of the scoliosis deformity
- Maintain the scoliosis correction during growth
- Allow the spine to grow maximally
- Minimize number of surgeries
- No complications
- Minimize number of outpatient clinic visit
- Maximize patient activities and function
- No pain
So, what are good, currently utilized treatment options, keeping the above-mentioned treatment goals in mind?
- Placement of new single (unilateral) MAGEC growing rod with a longer, bigger device.
- Placement of a two (dual) MAGEC growing rods
- Shilla Growth Guidance System
My preferred treatment is to use the Shilla Growth Guidance System, which can achieve all 8 of our treatment goals.
Getting back to our 6-year-old patient……he underwent conversion from the single MAGEC growing rod to a T3-L2 Shilla Growth Guidance System (pictured below).
The worst part of the scoliosis is from T8-T10 (red box) so this part of the spine was maximally straightened and fused, so this will correct and permanently stabilize this part of the spine. The rods and screws above and below the red box are NOT fused, so as the patient grows, the screws will grow away from the screws in the red box. This is like a track and trolley system, guiding growth.
Above the patient is now 1 year after surgery, doing well, deformity controlled and he is doing normal activities for his age.
We will jump to his last follow-up (above) which is 5 YEARS after surgery. He is 11 years old, participating in normal activities and he has not had any additional surgeries.
We can see from the immediate radiograph after his surgery 5 years ago, to the most recent radiographs there has been significant growth of his spine. This is easily demonstrated by looking at how much of the rods are protruding at the top and bottom of the construct. The sliding screws have moved away from the middle and are closer to the ends of the rods. We will allow him to keep growing and keep him out of the operating room for as long as possible!
The use of a single, unilateral growing rod and then conversion to Shilla Growth Guidance System has proven to be a safe, effective treatment plan for young children with severe, progressive scoliosis, which cannot be appropriately treated with casting and bracing.