स्पाइन जर्नल

Innovative Method of Gradual Temporary Distraction Using Magnetic Growing Rods (MCGR) for Surgical Treatment of Severe Kyphoscoliosis: Mini-case Series

Abstract

Greggi T, Maredi E, Vommaro F, Lolli F, Martikos K, Giacomini S, Di Silvestre M, Baioni A, Scarale A, Morigi A and Bacchin MR

Introduction: Surgical treatment for severe scoliosis has been characterized by a combined approach and gradual distraction before final arthrodesis; pedicle screws have reaffirmed the role of posterior approach.

Materials and Methods: Three female patients were treated for severe scoliosis using transient magnetic rods for internal distraction followed by magnetic rod removal and definitive PSF.

MCGR: Case A: 12-year-old female with severe thoracic scoliosis of 120°. First Stage: release (Ponte’s osteotomies), pedicle screws T3-L4 with MCGR, then daily ultrasound guided lengthening with external magnet controller for 3 weeks followed by second stage posterior arthrodesis and thoracoplasty.

Case B: 15-year-old female with thoracic kyphoscoliosis of 115°. The same technique as in case A was performed: pedicle screw instrumentation from T3 to L4.

Case C: 21-year-old female with Noonan syndrome. Thoracic kyphoscoliosis of 130°, the same technique as in case A was performed: pedicle screw instrumentation T4-L3.

Results: A. First stage: Scoliosis decreased to 75°. After the second operation it was equal to 42° with a total correction of 65%. No neurological complication.

B. First stage: Scoliosis decreased to 72°. After the second stage it was 45° with a total correction of 60%. No neurological complication.

C. First stage: Scoliosis decreased to 80° (correction of 38%). The patient showed reduced bone mineral density and developed respiratory distress: she was admitted to an Intensive Care unit. Last x-rays revealed a scoliosis and kyphosis correction in Cobb degrees equal to 59° (correction rate of 49%) and 43° (correction rate of 48%), respectively. Follow-up at two months showed scoliosis and kyphosis in Cobb degrees of 59° and 44°, respectively.

Conclusion: The MGCR is a valid alternative when the use of halo is contraindicated in the presence of myeloradicular malformations or halo traction is not well tolerated by the patient or their family. Results are comparable in terms of correction and the psychological effect of MGCR elongation is favorable. All of the data are available in literature.