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Rios F, Elsebaie HB, Shahidi B, Ames R, Monjazeb B, Kerr W, Pahys JM, Hwang SW, Samdani AF, Andras LM, Oetgen ME, Newton PO, Yaszay B, Mundis GM, Akbarnia BA. Proximal foundation anchor variations and their correlation with unplanned return to the operating room (UPROR) in children with EOS treated with magnetically controlled growing rods (MCGR). Spine Deform 2024:10.1007/s43390-024-00921-z. [PMID: 38997612 DOI: 10.1007/s43390-024-00921-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2024] [Accepted: 06/16/2024] [Indexed: 07/14/2024]
Abstract
INTRODUCTION The evolution of MCGR technique has led to modifications in the configuration of the proximal construct to decrease the incidence of implant-related complications (IRC) and revision surgeries. However, there is no data characterizing the performance of the most used configurations reducing the risk of complications. METHODS 487 patients were identified from an international multicenter EOS database. INCLUSION CRITERIA EOS patients, primary dual MCGR, complete radiographs, and minimum of 2-year follow-up. 76 patients had incomplete X-rays, 5 had apical fusions, and 18 had inconclusive complications, leaving 388 patients for review. A digital spine template was created to document UIV; number of levels; number, type, and location of anchors; as well as implant configuration. First available postoperative and latest follow-up radiographs were reviewed by two senior surgeons and two spine fellows. UPROR due to IRC was defined as any change in proximal anchors between the postoperative and final follow-up radiographs. RESULTS The most common proximal construct configuration: UIV at T2 (50.0%) with 17.5% UPROR, followed by T3 (34.0%) with 12.1% UPROR; number of levels was three (57.1%) with 16.8% UPROR and two (26.0%) with 17.0% UPROR; number of proximal anchors was six (49.9%) with 14.1% UPROR and four (27.0%) with 18.3% UPROR. The most common anchors were all screws (42.0%) with 9.9% UPROR, and all hooks (26.4%) with 31.4% UPROR (P < 0.001). The construct with the lowest rate of UPROR was a UIV at T2, with six anchors (all screws) across three levels (42 cases), with 0% UPROR. Other construct combinations that yielded 0% UPROR rates were UIV of T3, six anchors (all screws) across three levels (25 cases), and a UIV of T3 with six anchors (screws and hooks) across three3 levels (9 cases). CONCLUSION Proximal anchor configuration impacts the incidence of UPROR due to IRC in MCGR. UIV at T2 and T3 compared to T4, and the use of all screws or combination of screws and hooks compared to all hooks were associated with a lower UPROR rate. The most common construct configuration was T2 UIV, three levels, six anchors, and all screws. The use of a combination of six anchors (screws or screws and hooks) across three levels with a UIV at T2 or T3 was associated with a lower UPROR rate. Additional research is needed to further evaluate the variables contributing to configuration selection and their association with IRC.
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Affiliation(s)
- Fernando Rios
- San Diego Spine Foundation, 6190 Cornerstone CT #212, San Diego, CA, 92121, USA
| | - Hazem B Elsebaie
- San Diego Spine Foundation, 6190 Cornerstone CT #212, San Diego, CA, 92121, USA
| | - Bahar Shahidi
- San Diego Spine Foundation, 6190 Cornerstone CT #212, San Diego, CA, 92121, USA
- University of California, San Diego, CA, USA
| | - Robert Ames
- San Diego Spine Foundation, 6190 Cornerstone CT #212, San Diego, CA, 92121, USA
| | - Bailee Monjazeb
- San Diego Spine Foundation, 6190 Cornerstone CT #212, San Diego, CA, 92121, USA
| | - William Kerr
- San Diego Spine Foundation, 6190 Cornerstone CT #212, San Diego, CA, 92121, USA
| | | | | | | | | | | | | | - Burt Yaszay
- Seattle Children's Hospital, Seattle, WA, USA
| | - Gregory M Mundis
- San Diego Spine Foundation, 6190 Cornerstone CT #212, San Diego, CA, 92121, USA
- Scripps Clinic, La Jolla, CA, USA
| | - Behrooz A Akbarnia
- San Diego Spine Foundation, 6190 Cornerstone CT #212, San Diego, CA, 92121, USA.
- University of California, San Diego, CA, USA.
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Hammad AM, Emar M, Shahin F, Aljuba A, Hasani A, Awad M, Abdelnabi S, Gayaswal D, Armouti M, Shekhar S, Garg B, Ahmad AA. A Prospective Multicenter ≥2 Years Clinical Study of the Active Apex Correction (APC) Technique in Early Onset Scoliosis (EOS) Patients. Global Spine J 2024:21925682241229677. [PMID: 38266098 DOI: 10.1177/21925682241229677] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/26/2024] Open
Abstract
STUDY DESIGN prospective multicenter study. OBJECTIVES Active apex correction (APC) is posterior tethering technique for correction of early onset scoliosis (EOS) via reverse modulation at the apex. Active apex correction has been increasingly used worldwide. This study aimed to assess short-term outcomes of multicenter study with ≥2 years of APC on spine length, curve correction, complications, unplanned surgeries, and proposed low crankshaft phenomena incidence. METHODS Prospective multicenter study including 24 EOS patients treated by APC; involves inserting and compressing pedicle screws on convex side of apex proximal and distal to most wedged vertebra allowing apex modulation according to Hueter-Volkmann law. Excluded patients with <2 years follow-up whom APC was not primary surgery. RESULTS Mean age 85.97 ± 32.43 months, 71% congenital scoliosis, mean follow-up 35.54 ± 12.36 months. At final follow-up, statistically significant improvement in Cobbs angle (∆ = 23.96%, P < .0001), spinal length T1-T12 (∆ = 12.83%, P < .0001), T1-L5 (∆ = 13.41%, P < .0001) but not in apical vertebral translation (AVT) albeit clinical improvement (∆ = 7.9%, P = .36) compared to preoperative measurements. Comparing immediate postoperative measurements to >2 years follow-up, statistically significant improvement in spinal length T1-T12 (∆ = 6.03%, P = .0002) and T1-L5 (∆ = 6.26%, P < .0001) but not in Cobbs angle (∆ = 4.93%, P = .3) or AVT (∆ = 14.77%, P = .25). 9 complications requiring 3 unplanned surgeries recorded in all patients including 2 broken rods, 2 adding-on and 4 screw dislodgement. CONCLUSION Active apex correction is a novel technique that has been incorporated in several countries as treatment modality for EOS. Short-term outcomes are promising in terms of clinical improvement, complication rates and decreased need for multiple operations or unplanned surgeries.
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Affiliation(s)
- Ahmad M Hammad
- Department of Orthopedics Surgery, American University of Beirut (AUB), Beirut, Lebanon
| | - Mohammad Emar
- Department of Orthopedics Surgery, Palestine Polytechnic University (PPU), Hebron, Palestine
| | - Farah Shahin
- Department of Orthopedics Surgery, Palestine Polytechnic University (PPU), Hebron, Palestine
| | - Ayat Aljuba
- Department of Orthopedics Surgery, Palestine Polytechnic University (PPU), Hebron, Palestine
| | - Asala Hasani
- Department of Orthopedics Surgery, Palestine Polytechnic University (PPU), Hebron, Palestine
| | - Mohammad Awad
- Department of Orthopedics Surgery, Palestine Polytechnic University (PPU), Hebron, Palestine
| | - Siraj Abdelnabi
- Department of Orthopedics Surgery, Palestine Polytechnic University (PPU), Hebron, Palestine
| | - Daksh Gayaswal
- Department of Orthopedics Surgery, University of Toledo, Toledo, OH, USA
| | - Mohammad Armouti
- Department of Orthopedics Surgery, Abdali Hospital, Amman, Jordan
| | - Shubhankar Shekhar
- Department of Orthopedics Surgery, All India Institute of Medical Sciences (AIIMS), New Delhi, India
| | - Bhavuk Garg
- Department of Orthopedics Surgery, All India Institute of Medical Sciences (AIIMS), New Delhi, India
| | - Alaaeldin A Ahmad
- Department of Orthopedics Surgery, Palestine Polytechnic University (PPU), Hebron, Palestine
- Department of Orthopedics Surgery, University of Toledo, Toledo, OH, USA
- Department of Orthopedics Surgery, Abdali Hospital, Amman, Jordan
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Tognini M, Hothi H, Dal Gal E, Shafafy M, Nnadi C, Tucker S, Henckel J, Hart A. Understanding the implant performance of magnetically controlled growing spine rods: a review article. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2021; 30:1799-1812. [PMID: 33666742 DOI: 10.1007/s00586-021-06774-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/02/2020] [Revised: 01/14/2021] [Accepted: 02/13/2021] [Indexed: 10/22/2022]
Abstract
PURPOSE Early-Onset Scoliosis (EOS) (defined as a curvature of the spine ≥ 10° with onset before 10 years of age) if not properly treated, can lead to increased morbidity and mortality. Traditionally Growing Rods (TGRs), implants fixated to the spine and extended every 6-8 months by surgery, are considered the gold standard, but Magnetically Controlled Growing Rods (MCGRs) avoid multiple surgeries. While the potential benefit of outpatient distraction procedure with MCGR is huge, concerns still remain about its risks, up to the release of a Medical Device Alert (MDA) by the Medicines and Healthcare Regulatory Agency (MHRA) advising not to implant MCGRs until further notice. The aim of this literature review is to (1) give an overview on the use of MCGRs and (2) identify what is currently understood about the surgical, implant and patient factors associated with the use of MCGRs. METHODS Systematic literature review. RESULTS Surgical factors such as use of single rod configuration or incorrect rod contouring might affect early failure of MCGRs. Patient's older age and higher BMI are correlated with rod slippage. Wear debris and distraction mechanism failure may result from implant design and iteration. CONCLUSION Despite the complications reported, this technology still offers one of the best solutions to spine surgeons dealing with severe EOS. Lowering the complication rate by identifying risk factors for failure is possible and further studies in this direction are required. Once the risk factors are well described, some of these can be addressed enabling a safer use of MCGRs.
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Affiliation(s)
- Martina Tognini
- The Royal National Orthopaedic Hospital and Institute of Orthopaedics and Musculoskeletal Science, University College London, Stanmore, UK.
| | - Harry Hothi
- The Royal National Orthopaedic Hospital and Institute of Orthopaedics and Musculoskeletal Science, University College London, Stanmore, UK
| | - Elisabetta Dal Gal
- The Royal National Orthopaedic Hospital and Institute of Orthopaedics and Musculoskeletal Science, University College London, Stanmore, UK
| | - Masood Shafafy
- Department of Trauma and Orthopaedics, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - Colin Nnadi
- Nuffield Orthopaedic Centre, Oxford University Hospital, Headington, Oxford, UK
| | - Stewart Tucker
- Great Ormond Street Hospital for Children, NHS Foundation Trust, London, UK
| | - Johann Henckel
- The Royal National Orthopaedic Hospital and Institute of Orthopaedics and Musculoskeletal Science, University College London, Stanmore, UK
| | - Alister Hart
- The Royal National Orthopaedic Hospital and Institute of Orthopaedics and Musculoskeletal Science, University College London, Stanmore, UK
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Riemann MC, Bailey SS, Rubert N, Barnes CE, Karlen JW. Sonography of Magnetically Controlled Growing Rods: A Quality Initiative in the Creation of a Multidisciplinary Clinic. JOURNAL OF DIAGNOSTIC MEDICAL SONOGRAPHY 2020. [DOI: 10.1177/8756479320946722] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Objective: The MAGEC (Magnetic Expansion Control) rods were introduced to a medical institution in 2015. The rod expansion procedures were initially evaluated with radiographs. The staff undertook a quality initiative to reduce radiation exposure by utilizing sonography. Material and Methods: The radiation dose for a typical visit was measured by examining DICOM imaging data, stored in PACS. Imaging visit time was determined from the difference between times of first radiograph/sonogram before distraction to last radiograph/sonogram after distraction. Results: The 21 patients (8 male, 13 female) were an average age of 11.4 ± 2.82 years (age at implant = 7.5 ± 1.94) when evaluated. The average length of time for a radiographic visit was 40.7 ± 20.7 minutes, whereas a sonography visit was 10.7 ± 3.7 minutes. Radiation dose per study visit prior to the introduction of the MAGEC clinic was 0.42 ± 0.39 mSv. Given an ideal patient schedule, the MAGEC clinic could reduce radiation dose by 1.3 to 2.5 mSv annually, with 95% confidence. Conclusion: This quality improvement study demonstrated a reduction in radiation exposure and imaging time. The added benefits were providing a successful multidisciplinary imaging clinic and creation of a new exam that aligned with the “ultrasound first” initiative.
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