A minimum of 2 year follow up of 22 EOS patients who were treated with 2nd generation MCGR

Karsten Ridderbusch, Christian Hagemann, Ralf Stücker

Childrens Hospital Hamburg-Altona

University Clinic Hamburg

Disclosures

• Consultant

– Synthes GmbH– Ellipse

Childrens Hospital Hamburg-Altona

Patients• 22 EOS patients had primery surgery with 2nd

generation MCGR (MAGEC★) • All surgeries were done in double rod technique • Single center• Inclusion criteria for study

– EOS of any etiology– > 40° scoliosis and > 5° progression / year– Minimum follow-up of 24 months and at least 6

lengthening procedures (lengthening is performed every 4 months)

Childrens Hospital Hamburg-Altona ★ Cleared by FDA 2‘ 2014

Patients• 15 female, 7 males

• Age: 8.8 (4.6-14.3 years)

• 7 neuromuscular, 6 syndromic, 4 neurofibromatosis, 2 idiopathic, 2 thoracogenic, 1 congenital scoliosis

• 20 thoracic, 1 thoracolumbar, 1 lumbar curves

• Average F/U – 31 months, (24-46 months)

Childrens Hospital Hamburg-Altona

Surgical technique• 2 separate incisions• 4 screws as distal monosegmental foundation• 4 screws + 2 clamps proximally• Dual 5.5 mm rods• Contouring• Testing of distraction• Subfascial positioning• Cross linking

Childrens Hospital Hamburg-Altona

Distractions

• Outpatient procedure• Use of Dimeglio data• X-rays pre and post lengthenings• Ultrasound documentation of lengthening• 4 months intervalls

– Logistic reasons– Reduce radiation exposure

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Radiographic analysis• Cobb angle

• T1-T12 length

• T1-S1 length

• Kyphosis (T1-T12)

• Lordosis (L1-L5)

Childrens Hospital Hamburg-Altona

ResultsPre-op Post-op Change (%) FU Change (%)

Cobb (°) 61 ± 14 28 ± 10 54 27 ± 13 56

Kyphosis (°) 44 ± 24 28 ± 12 36 35 ± 14 20

Lordosis (°) 41 ± 15 31 ± 12 24 41 ± 9 15

T1-T12 (cm) 18.3 ± 2.5 20.4 ± 2.6 11 22.5 ± 2.7 23

T1-S1 (cm) 29.6 ± 4.3 33.3 ± 4.3 13 35.5 ± 3.9 20

= statistically significant (p < 0,05)Childrens Hospital Hamburg-Altona

Complications• 7 patients had at least 1 complication which

leads to revision surgery

• 4 junctional kyphosis• 2 screw pull out• 1 lumbar adding on• 1 deep wound infection• 1 actuator pin broke

Childrens Hospital Hamburg-Altona PJK

Curve correction and T1-S1 growthAuthor Cobb before

surgery(only primary procedures)

Cobb after surgery

Correction in %

Cobb at follow-upCorrection in %

T1-S1 growth/month

Cheungn=2

67° 25° (67%) 29° (57%) 1 mm

Dannawin=34

69° 47° (32%) 41° (41%) 0,9 mm

AkbarniaN=14

60° 34° (43%) 31° (48%) 1,6 mm

Hickeyn=4

74° 42° (43%) 42° (43%) 0,4 mm (2 patients)

HamburgN=22

61° 28° (54%) 27° (56%)Ø 31 months FU

0,7 mmØ 31 months FU

Childrens Hospital Hamburg-Altona

MCGR - results

• Results in terms of correction and maintaining correction comparable to traditional growing rods

• Safe and effective non fusion technology• Distraction mechanism reliable• Complications rate acceptable compared to

conventional GR

Childrens Hospital Hamburg-Altona

Questions to be answered

• What is the complication rate after longer follow-up ?

• Is distraction mechanism reliable after longer follow-up ?

• Can autofusion be avoided ?• What is the best distraction protocoll ?

Childrens Hospital Hamburg-Altona