It's MAGEC: Helping Children with Scoliosis
January 20, 2019
Magnetically controlled growing rods help children with early onset scoliosis avoid multiple surgeries
Innovations in Orthopaedics - Winter 2019
Early-onset scoliosis (EOS) refers to spine deformity present before 10 years of age. When braces or casts don't help, doctors often recommend scoliosis surgery to straighten the curve or stop its progression.Early-onset scoliosis (EOS) refers to spine deformity present before 10 years of age. When braces or casts don't help, doctors often recommend scoliosis surgery to straighten the curve or stop its progression.
Until recently, one surgery alone wouldn't do the job. If a child needed growing rods, that child would face multiple surgeries from childhood to puberty: one to insert metal rods along the spine, followed by two surgeries per year to lengthen the rods and keep the spine in a straighter position.
With the launch of MAGEC (MAGnetic Expansion Control), which NuVasive introduced in the U.S. market in April 2014, children no longer have to endure multiple surgeries to straighten their spine. Magnetic technology and remote control allow doctors to lengthen the spine during a short, non-invasive outpatient visit. Doctors consider MAGEC a “game-changer” for EOS treatment.
Christina Hardesty, MD, Pediatric Orthopaedic Surgeon, University Hospitals Rainbow Babies & Children’s Hospital, says UH currently has at least 12 patients with MAGEC rods in place. “The kids are happy to come in to the office to get a little taller, and they're back in school the same day,” she says. “They don't seem to be bothered by the lengthening process. Parents are very happy their kids don't need multiple surgeries.”
Because MAGEC requires only one surgery instead of several, the system reduces risk of surgical complications and infections. Fewer surgeries also means less anesthesia exposure. Studies have linked repeated anesthesia exposure to cognitive deficits, increased anxiety and an increased risk of attention deficit disorder.
HOW MAGEC WORKS
Much like the traditional rod-lengthening procedure, EOS patients first undergo surgery to implant MAGEC rods using screws and/or hooks. The rods have telescoping housing that allows them to lengthen.
About every three months, the patient returns to the doctor's office for a lengthening. The doctor first measures the rods' length with ultrasound. Using ultrasound instead of X-Ray reduces radiation exposure.
Next, the doctor holds a remote-controlled magnetic device over the back to lengthen the rods for about 30 seconds, before measuring the rod length again. After that, the child goes home or back to school.
Although MAGEC procedures present fewer complications than traditional rod-lengthening surgeries, the system does have a few risks that are similar to traditional growing rods. Hooks or screws can pull out of place or a rod can fracture.
It's also possible for children to outgrow their rods, which would require a second surgery. There are two sizes of rods that can expand 28 or 48 millimeters. If the rod reaches its maximum length, the surgeon may decide to exchange the rods and continue treatment.
Aside from straightening the spine through noninvasive procedures, children who use MAGEC have experienced additional health benefits. Without surgery, EOS patients suffer diminished lung function and other complications.
“We don't go into surgery expecting things to change; we expect to control the spinal curve,” Dr. Hardesty says. “But we've had several patients who can breathe better, no longer need a BiPap machine at night, or have gained weight because they can eat better. Those are nice side effects that come with EOS surgery."
AN EARLY MAGEC ADOPTER
UH Rainbow Babies & Children’s Hospital is one of a small group of U.S. hospitals that treat EOS. Dr. Hardesty, Jochen Son-Hing, MD, a pediatric orthopaedic surgeon at UH Rainbow Babies & Children’s Hospital, and George H. Thompson, MD, former Division Chief of Pediatric Orthopaedic Surgery at UH Rainbow Babies & Children’s Hospital, started using MAGEC on select patients in 2015.
“It's practice-changing,” Dr. Hardesty says. “We have a relatively high volume of kids now growing every three months. We've gotten very efficient at planning lengthenings. These kids are growing their spines MAGEC-ally.”
To refer a patient with scoliosis, or for more information about MAGEC, call 216-844-8350.