1-21-2025
This is a case of a 9 year old female with a chromosomal deletion and early-onset scoliosis. She was managed nonoperatively for many years, due to slow progression and the deformity remained very flexible. However, she developed more sitting imbalance, sitting intolerance and the deformity started to become more stiff, hence discussion switched to discuss surgical treatment options. The scoliosis is 110 degrees (should be 0 degrees) and the pelvic is tipped by 22 degrees (should be 0 degrees).
The discussion was between a definitive posterior spinal fusion and a distraction-based growing rod construct. Her T1-T12 distance was 19 cm and she was very small framed female. Parents wanted to proceed with a treatment that allowed the spine to grow, fully understanding there would be complications occurring at some point.
The surgical procedure was from T2-pelvis dual magnetic growing rods. The top foundation was on the spine, from T2-T4 with pedicle screws and a short fusion T2-T4. At the bottom screws were placed at L5, S1 and the bilateral ilium, also with a short fusion L5-S1. Between these two “foundations” were placed two magnetically controlled growing rods, or MAGEC rods. Overall there was excellent correction of the scoliosis and the pelvis is now much more level, which will allow her sit better in her wheelchair.
Here she is 2 years after surgery. The lengthenings of the magnetic growing rods occurred every 3 months in the outpatient clinic.
Here she is 3 years after surgery. Note the lucency in the bulbous area of the growing rods. This shows how much the rods have lengthened, with the right rod fully lengthened, and the left nearly fully lengthened. She is now 12 year old. Because there was not much further vertical spine growth a decision was made to convert her over to a definitive spinal fusion.
3 years, 6 months after intial procedure. When we convert from a growing rod to a definitive fusion, most, if not all, the screws are removed and larger screws are inserted (due to loosening) and the rods are completely removed. More correction of the scoliosis and pelvic are obtained, with insertion of more screws and two new non-lengthening rods. She is now in her permanent new position.
The patient is now 16 year old and is doing well 3 years, 3 months after surgery. These implants will stay in forever. She is doing well with excellent sitting position, no back pain and is breathing well.
This case nicely demonstrates:
- We can often wait to do spine deformity surgery, especially when spinal flexibility is maintained.
- Shared decision-making about defintive spine fusion vs. growing rods.
- Strong “foundations” at the top with T2-T4 pedicle screws and at the bottom with L5-pelvis screws allows a strong, durable construct during the lengthening process.