Magnetically Controlled Growing Rods: Sagittal Plane Analysis and the Risk of Proximal Junctional Kyphosis Purnendu Gupta, Felix Brassard, Jennifer Schottler,

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Presentation transcript:

Magnetically Controlled Growing Rods: Sagittal Plane Analysis and the Risk of Proximal Junctional Kyphosis Purnendu Gupta, Felix Brassard, Jennifer Schottler, Alicia January, Ron El-Hawary, Ben Roye, Jeff Sawyer, Kim Hammerberg, CSSG Purnendu Gupta, M.D. Chief of Staff Shriners Hospitals for Children: Chicago Clinical Professor of Orthopaedic Surgery University of Illinois, Chicago

Disclosures Purnendu Gupta Felix Brassard Jennifer Schottler Nothing to disclose Felix Brassard Jennifer Schottler Alicia January Ron El-Hawary Apifix Ltd.: Paid consultant Children's Spine Study Group: Board or committee member DePuy, A Johnson & Johnson Company: Paid consultant; Research support Medtronic: Paid consultant; Research support Pediatric Orthopaedic Society of North America: Board or committee member Ben Roye SRS, OMeGA, POSNA: Research support Jeff Sawyer Children's Spine Foundation: Board or committee member DePuy, A Johnson & Johnson Company: Paid presenter or speaker Mosby: Publishing royalties, financial or material support Nuvasive: Paid presenter or speaker Wolters Kluwer Health - Lippincott Williams & Wilkins: Publishing royalties, financial or material support Kim Hammerberg CSSG DePuy Synthes, Nuvasive

Introduction/Methods Hypothesis: MCGR insertion may have increased risk of PJK due to actuator geometry Methods: Multi-center registry data Radiographic analysis pre-op, immediate post-op and 24 month follow up Inclusion/Exclusion: MCGR insertion with 12 and 24 month follow up

Results Preliminary data: N=28 Idiopathic (n=11) Neuromuscular (n=11) Congenital (n=3) Syndromic (n=3)

Results Preliminary data 2-12 years of age Pre-op curves: (M= 69.8±14.4 degrees) 194 lengthenings (M = 6.93/patient) 16 (57%) male, 12 (43%) female patients M = 7.8 (±2.7) years at initial implant

Results Preliminary data: Scoliosis improved from 69.8±14.4 degrees pre-op to 40.2±15.2 immediate post-op (p<.001) 42.6±14.5 at 24-month follow-up (p<.001) Increase in T1–T12 length from 16.9cm±3.3 pre-op to 19.2cm±3.0 post-op (p<.001) 20.1cm±3.6 at 24-month follow-up (p<.001)

Results Preliminary data: 12 complications occurred in 7 (25%) of patients 4 implant failures 2 device migrations 2 infections 2 neurogenic pain 1 rod fracture 1 wound dehiscence

Results Preliminary data No significant changes in thoracic kyphosis (TK) Pre-op to Post-op (25.4 vs. 26.2, p=.799) Pre-op to 24 months (23.7 vs. 28.6, p=.072) No significant changes in lumbar lordosis (LL) Pre-op to Post-op (-51.8 vs. -45.2, p=.118) Pre-op to 24 months (-48.4 vs. -58.5, p=.268)

Results Preliminary data: T1 slope changed Pre-op to post-op (16.9 vs. 21.2; p=.044) Pre-op to 24-month follow-up (15.9 vs. 21.2; p =.039) At 24-month evaluation, PJK developed in 2 of 22 (9%) patients

Case A: PJK with revision January 2014 April 2014 May 2016 55º 44º

Case B: PJK with revision August 2014 October 2014 December 2016 41º 31º 19º

Conclusions Significant increase in T1 tilt No significant change in thoracic kyphosis or lumbar lordosis Rate of PJK 9% (n=2) Unable to differentiate between 70mm and 90mm actuator with respect to PJK due to sample size Larger data set and longer study time needed