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
Although the outcomes of using magnetically controlled growing rods (MCGR) to treat early onset scoliosis (EOS) has been reviewed, these studies 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 gain a deeper understanding of how modification to MCGR after affected patients outcomes for the treatment of EOS and the implications of these effects on the reporting of future MCGR.
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 (25%) included mixed implant iteration leaving a total of 271 patients identified through 15 clinical studies that met inclusion criteria. 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 implant with Keeper plates have less post-operative distraction failures. Of the currently published studies, 25% include mixed implant designs. Future studies reporting on MCGR outcomes should include implant iteration in their analysis. MCGR implant with Keeper plates have less post-operative distraction failures. Of the currently published studies, 25% include mixed implant designs. Studies included mixed implant iterations could be artificially inflating postoperative complication rates. Have more recent implant modification exhibited similar effects on MCGR outcomes. Twenty-five percent of currently published studies on MCGR outcomes included mixed implant iterations which could be artificially inflating complication rates. The addition of the keeper plate has decreased the incidence of distraction failure in the treatment of EOS. Understanding implant design gives important insight to understanding how they affect patient outcomes.
Future studies should include implant iterations in the reporting of MCGR outcomes for the treatment of EOS. Long-term follow-up of children treated with MCGR for EOS. Subdividing MCGR outcomes by implant iteration will help ensure complications rates are not artificially inflated.