Published online Oct 28, 2019. doi: 10.5312/wjo.v10.i11.394
Peer-review started: May 8, 2019
First decision: July 31, 2019
Revised: September 6, 2019
Accepted: October 7, 2019
Article in press: October 7, 2019
Published online: October 28, 2019
Magnetically controlled growing rods (MCGR) are a novel treatment option for early onset scoliosis (EOS). Although the complication profile with MCGR use has been reviewed, these reviews do not take into account important implants modifications, termed iterations, that were made due to early on postoperative complications is not well reported or understood.
To assess the effect of MCGR implant iterations on post-operative complications in EOS.
A systematic review was performed to identify studies investigating MCGR specifically for the treatment of EOS, refined to those reporting the implant iteration, specifically the incorporation of the keeper plate to the implant design. Articles with mixed implant iteration usage were excluded. Complications following surgery were recorded as well as potential risk factors and compared between implant cohorts.
Although 20 articles were identified for inclusion, 5 included mixed implant iteration leaving a total of 271 patients identified through 15 clinical studies that met inclusion criteria. The average follow-up was 25.4-mo. Pre-keeper plate implants were utilized in 3 studies with a total of 49 patients. Overall, 115 (42.4%) post-operative complications were identified, with 87% defined as major. The addition of the keeper plate significantly decreased the rate of post-operative complications per study (35.7% vs 80.6%, P = 0.036), and the rate of distraction failure (8.1% vs 40.8%, P = 0.02). Unplanned reoperation occurred in 69 (26.7%) patients but was not different between implant iteration cohorts (25.5% without keeper plate vs 27.1% with keeper plate, P = 0.92).
MCGR for EOS has a cumulative complication rate of 42.4% but this is significantly reduced to 35.7% when reviewing only keeper-plate enabled implants. However, 25% of published articles included mixed implant iterations. Future studies should discern between implants iterations when reporting on the usage of MCGR for EOS.
Core tip: Magnetically controlled growing rods (MCGR) are a novel treatment approach for early onset scoliosis which is gaining increases clinical usage. Since its introduction, numerous modifications have been implemented to improve the performance of the construct, however, these modifications are often over-looked in current published series. This study evaluated the effect of the addition of the keeper plate to MCGR, finding that it had a significant impact on decreasing the rate of post-operative distraction failures. Despite the impact of this modification, 25% of published articles included mixed implant designs in their series, potentially inflating reported complication rates.