Early Experience of Frequent Small Increments Lengthening of Magnetic Spinal Growing Rods in Children with Severe Early Onset Scoliosis Joseph Ivan Krajbich.

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Early Experience of Frequent Small Increments Lengthening of Magnetic Spinal Growing Rods in Children with Severe Early Onset Scoliosis Joseph Ivan Krajbich MD, FRCS(C) Shriners Hospital for Children Portland, OR

Hypothesis Frequent, small increment of magnetic spinal growth rods (MSGR) lengthening similar to principles of limb lengthening and tissue expansion, will allow atraumatic gradual rod lengthening, accommodating both growth and additional curve correction

Methods Cohort of patients with early onset scoliosis were treated with the following treatment protocol: Patient with severe (>65 deg) EOS included in the study Patients with scoliosis >70 deg placed in Halo gravity traction prior to rod implant MSGR’s lengthen every 6 weeks using set 2 to 3 mm lengthening Amount of lengthening achieved and Cobb measured on radiographs

Results 13 patients included in the study Various etiology Average pre treatment Cobb 91deg Range 67 – 114 Average pre rod implant/post halo Cobb 69deg Immediate post implant average Cobb was 49deg The average follow up was 13.3 months

Results First lengthening at 6 weeks post implant Subsequent lengthening every 6 weeks No cast or brace post implant No activity restriction other than contact sports

Results All rods continue to lengthen regardless of the length of follow up Final average Cobb was 46deg The average lengthening per clinic visit - 3.1mm

Results All wound healed per primum No early or late infection No implant failure No anchor failure or issues No junctional kyphosis

8 y/o with NF1 Post halo traction Post rods insertion 2 year follow up

Conclusions Small increment, frequent lengthening of MSGR’s would appear to be safe, effective method of controlling scoliosis curve in EOS population.