Skip to main content
Log in

Unplanned return to the operating room (UPROR) occurs in 40% of MCGR patients at an average of 2 years after initial implantation

  • Case Series
  • Published:
Spine Deformity Aims and scope Submit manuscript

Abstract

Purpose

This study calculated the rates of Unplanned Return to the Operating Room (UPROR) in early-onset scoliosis patients who had no previous spine surgery and underwent Magnetically Controlled Growing Rod (MCGR) implantation.

Methods

We reviewed surgical, radiographic, and UPROR outcomes for EOS patients treated with the MCGR implant < 12 years + 11 months of age, had complete preop/postop major curve measurements, and had complete MCGR details.

Results

376 patients underwent MCGR implantation at a mean age of 7.7 years (1.8–12.9). Diagnoses included 106 (28%) idiopathic, 84 (22%) syndromic, 153 (41%) neuromuscular, and 33 (9%) congenital. The mean preop-cobb was 76.7° (9–145°), and an immediate postop correction was 41% (0–84%). We found that 38% (142/376) of patients experienced an UPROR prior to the maximal actuator length being achieved. UPROR occurred at mean 2 years (3 days–5 years) after initial implantation. Of the 142 patients who experienced UPROR there were 148 complications that lead to an UPROR. The most common reason for UPROR was anchor (55/148: 37%) or MCGR implant related (33/148: 22%). Wound related (22/148:15%), Neuro related 4/148: 3%), and other (34/148: 23%) accounted for the remaining UPROR occurrences.

Conclusion

In conclusion, the MCGR UPROR rate was 142/376 (38%) after an average of 2 years post implantation. At 2-year follow-up, only 20% of MCGR patients had experienced an UPROR. However, between 2 and 5 years, the development of an UPROR increased precipitously with only 39% of MCGR patients remaining UPROR free at 5 years post MCGR implantation. The most common reason for UPROR was related to anchor or MCGR implant-related complications. This information can be utilized to set realistic expectations about the need and timing of future surgical procedures with patients and their families.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Subscribe and save

Springer+ Basic
EUR 32.99 /Month
  • Get 10 units per month
  • Download Article/Chapter or Ebook
  • 1 Unit = 1 Article or 1 Chapter
  • Cancel anytime
Subscribe now

Buy Now

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Fig. 1

Similar content being viewed by others

Data availability

Data will not be available.

References

  1. Akbarnia BA, Pawelek JB, Cheung KM et al (2014) traditional growing rods versus magnetically controlled growing rods for the surgical treatment of early-onset scoliosis: a case-matched 2-year study. Spine Deform 2(6):493–497. https://doi.org/10.1016/j.jspd.2014.09.050

    Article  PubMed  Google Scholar 

  2. Akbarnia BA, Cheung K, Noordeen H, Elsebaie H, Yazici M, Dannawi Z, Kabirian N (2013) Next generation of growth-sparing techniques: preliminary clinical results of a magnetically controlled growing rod in 14 patients with early-onset scoliosis. Spine (Phila Pa 1976) 38(8):665–670

    Article  PubMed  Google Scholar 

  3. Klyce WMS, Pawelek J, Skaggs DL, Sanders JO, Shah SA, McCarthy RE, Luhmann SJ, Sturm PF, Flynn JM, Smith JT, Akbarnia BA, Sponseller PD (2020) characterizing use of growth-friendly implants for early-onset scoliosis: a 10-year update. J Pediatr Orthop 40(8):e740–e746

    Article  PubMed  Google Scholar 

  4. Thakar C, Kieser DC, Mardare M, Haleem S, Fairbank J, Nnadi C (2018) Systematic review of the complications associated with magnetically controlled growing rods for the treatment of early onset scoliosis. Eur Spine J 27(9):2062–2071. https://doi.org/10.1007/s00586-018-5590-4

    Article  PubMed  Google Scholar 

  5. Kwan KYH, Alanay A, Yazici M et al (2017) Unplanned reoperations in magnetically controlled growing rod surgery for early onset scoliosis with a minimum of two-year follow-up. Spine (Phila Pa 1976) 42(24):E1410-e1414. https://doi.org/10.1097/brs.0000000000002297

    Article  PubMed  Google Scholar 

  6. Rushton PRP, Smith SL, Forbes L, Bowey AJ, Gibson MJ, Joyce TJ (2019) Force testing of explanted magnetically controlled growing rods. Spine (Phila Pa 1976) 44(4):233–239. https://doi.org/10.1097/brs.0000000000002806

    Article  PubMed  Google Scholar 

  7. Agarwal A, Kelkar A, Garg Agarwal A, Jayaswal D, Jayaswal A, Shendge V (2020) Device-related complications associated with magec rod usage for distraction-based correction of scoliosis. Spine Surg Relat Res 4(2):148–151. https://doi.org/10.22603/ssrr.2019-0041

    Article  PubMed  Google Scholar 

  8. Su AW, Milbrandt TA, Larson AN (2015) Magnetic expansion control system achieves cost savings compared to traditional growth rods: an economic analysis model. Spine (Phila Pa 1976) 40(23):1851–1856. https://doi.org/10.1097/brs.0000000000001077

    Article  PubMed  Google Scholar 

  9. Oetgen ME, McNulty EM, Matthews AL (2019) Cost-effectiveness of magnetically controlled growing rods: who really benefits? Spine Deform 7(3):501–504. https://doi.org/10.1016/j.jspd.2018.09.066

    Article  PubMed  Google Scholar 

  10. Polly DW Jr, Ackerman SJ, Schneider K, Pawelek JB, Akbarnia BA (2016) Cost analysis of magnetically controlled growing rods compared with traditional growing rods for early-onset scoliosis in the US: an integrated health care delivery system perspective. Clinicoecon Outcomes Res 8:457–465. https://doi.org/10.2147/ceor.S113633

    Article  PubMed  PubMed Central  Google Scholar 

  11. Rolton D, Richards J, Nnadi C (2015) Magnetic controlled growth rods versus conventional growing rod systems in the treatment of early onset scoliosis: a cost comparison. Eur Spine J 24(7):1457–1461. https://doi.org/10.1007/s00586-014-3699-7

    Article  PubMed  Google Scholar 

  12. El-Hawary AR, Akbarnia BA (2015) Early onset scoliosis—time for consensus. Spine Deform. https://doi.org/10.1016/j.jspd.2015.01.003

    Article  PubMed  Google Scholar 

  13. Williams BA, Matsumoto H, McCalla DJ, Akbarnia BA, Blakemore LC, Betz RR, Flynn JM, Johnston CE, McCarthy RE, Roye DP et al (2014) Development and initial validation of the classification of early-onset scoliosis (C-EOS). J Bone Joint Surg: Am 96:1359–1367. https://doi.org/10.2106/JBJS.M.00253

    Article  PubMed  Google Scholar 

  14. Williams BA, Matsumoto H, McCalla DJ, Akbarnia BA, Blakemore LC, Betz RR, Flynn JM, Johnston CE, McCarthy RE, Roye DP Jr, Skaggs DL, Smith JT, Snyder BD, Sponseller PD, Sturm PF, Thompson GH, Yazici M, Vitale MG (2014) Development and initial validation of the classification of early-onset scoliosis (C-EOS). J Bone Joint Surg Am 96(16):1359–1367

    Article  PubMed  Google Scholar 

  15. Anari JBFJ, Cahill PJ, Vitale MG, Smith JT, Gomez JA, Garg S, Baldwin KD, Children’s Spine Study Group (2020) Unplanned return to OR (UPROR) for children with early onset scoliosis (EOS): a comprehensive evaluation of all diagnoses and instrumentation strategies. Spine Deform 8(2):295–302

    Article  PubMed  Google Scholar 

  16. Murphy RF, Neel GB, Barfield WR, Anari JB, St Hilaire T, Thompson G, Emans J, Akbarnia B, Smith J, Mooney JF, 3rd; Pediatric Spine Study Group (2022) Trends in the utilization of implants in index procedures for early onset scoliosis from the pediatric spine study group. J Pediatr Orthop 42(9):e912–e916

    Article  PubMed  Google Scholar 

  17. Hu D, Flick RP, Zaccariello MJ et al (2017) Association between exposure of young children to procedures requiring general anesthesia and learning and behavioral outcomes in a population-based birth cohort. Anesthesiology 127(2):227–240. https://doi.org/10.1097/aln.0000000000001735

    Article  PubMed  Google Scholar 

  18. Tahir M, Mehta D, Sandhu C, Jones M, Gardner A, Mehta JS (2022) A comparison of the post-fusion outcome of patients with early-onset scoliosis treated with traditional and magnetically controlled growing rods. Bone Joint J. 104(2):257–264. https://doi.org/10.1302/0301-620x.104b2.Bjj-2021-1198.R1

    Article  PubMed  Google Scholar 

  19. Cheung JPY, Yiu K, Kwan K, Cheung KMC (2019) Mean 6-year follow-up of magnetically controlled growing rod patients with early onset scoliosis: a glimpse of what happens to graduates. Neurosurgery 84(5):1112–1123. https://doi.org/10.1093/neuros/nyy270

    Article  PubMed  Google Scholar 

  20. DE Lebel RB (2021) Helenius I Magnetically controlled growing rods graduation: deformity control with high complication rate. Spine 46(20):E1105–E1112

    Article  PubMed  Google Scholar 

  21. Shaw KA, Bassett P, Ramo BA et al (2023) The evolving stall rate of magnetically controlled growing rods beyond 2 years follow-up. Spine deform 11(2):487–493. https://doi.org/10.1007/s43390-022-00622-5

    Article  PubMed  Google Scholar 

  22. Suresh KV, Marrache M, Gomez J, Li Y, Sponseller PD (2022) Can magnetically controlled growing rods be successfully salvaged after deep surgical site infection? Spine Deform 10(4):919–923. https://doi.org/10.1007/s43390-022-00472-1

    Article  PubMed  Google Scholar 

  23. Scott JW (2001) Scott’s parabola: the rise and fall of a surgical technique. British Med J 323:1477. https://doi.org/10.1136/bmj.323.7327.1477

    Article  Google Scholar 

Download references

Acknowledgements

We want to thank the members and the staff at the Pediatric Spine Study Group (PSSG) for contributing to registry, maintaining the registry, and for allowing us to perform this study.

Funding

No funding was received for conducting this study.

Author information

Authors and Affiliations

Authors

Contributions

All authors contributed to the study’s conception and design. Material preparation, data collection and analysis were performed by Amy L. McIntosh, Anna Booth, and Matthew E. Oetgen. The first draft of the manuscript was written by Amy L. McIntosh and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript. Amy L. McIntosh, MD: substantially contributed to the design, data acquisition/interpretation, drafted and revised critically for important intellectual content, approved the final version to publish, agrees to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved. Anna Booth, BSN: substantially contributed to the design, data acquisition/interpretation, drafted and revised critically for important intellectual content, approved the final version to publish, agrees to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved. Matthew E. Oetgen, MD: substantially contributed to the design, data acquisition/interpretation, Drafted and revised critically for important intellectual content, approved the final version to publish, agrees to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.

Corresponding author

Correspondence to Amy L. McIntosh.

Ethics declarations

Conflict of interest

Mrs. Anna Booth has no relevant financial or non-financial interest to disclose. Dr. Matthew E. Oetgen has no competing interests to declare that are relevant to the content of the article, however, does report being a consultant/advisor for Medtronic. Dr. Amy L McIntosh is a paid speaker for NuVasive.

Ethical approval

PSSG sites must have IRB approval to participate. (Our site IRB #052011–039).

Consent to participate

Depending on local site requirements informed consent was obtained from participants and/or their parents/guardians. Consent was obtained at our site.

Consent for publication

Depending on local site requirements informed consent which includes information with regard to publishing their data. Consent was obtained at our site.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

McIntosh, A.L., Booth, A. & Oetgen, M.E. Unplanned return to the operating room (UPROR) occurs in 40% of MCGR patients at an average of 2 years after initial implantation. Spine Deform (2024). https://doi.org/10.1007/s43390-024-00911-1

Download citation

  • Received:

  • Accepted:

  • Published:

  • DOI: https://doi.org/10.1007/s43390-024-00911-1

Keywords

Navigation