Outcomes of MCGR at > 3 year average follow-up in severe scoliosis: who undergoes elective revision vs UPROR?

Abstract

The purpose of this study was to evaluate mid-term outcomes of magnetically controlled growing rods (MCGR), evaluate factors associated with unplanned return to the operating room (UPROR) vs achieving full length. Full length was defined as achieving > 85% of the elongating portion of the rod. IRB approved retrospective single site study. 106 patients underwent MCGR between 2014 and 2020, 58 met inclusion criteria, all genders, ethnicities, and etiologies were included. Patients with < 1 year follow-up or previous instrumentation were excluded. Follow-up averaged 43 months. 23 patients achieved full length 13 were revised to a new MCGR and 10 to a fusion; 5 were fused due to skeletal maturity; 12 were still lengthening; 2 were being observed; 16 experienced UPROR. Major curves improved from 80° (50-114) preoperative to 40° (7-78) at most recent follow-up or prior to revision, and 24° (4-57) after fusion. Fusion patients averaged 1.3 (1-4) procedures prior to fusion and gained 75 mm (38-142) in T1-S1 length. 16 patients experienced UPROR, 11 were male (p = 0.0238). All failures to elongate were male as was the rod fracture. Age was not correlated with UPROR (p = 0.318), but did correlate with implant-specific causes of UPROR. Specifically, anchor failure was associated with younger age and rod failure with older age at implantation (p = 0.013). There was no correlation between UPROR and major curve, flexibility or kyphosis. This is the largest site study evaluating mid-term outcomes in MCGR patients. At > 3.5 year follow-up 47% were electively revised, 27% underwent UPROR, 26% were still lengthening, and 3% were being observed. UPROR was associated with male gender and age at implantation was associated with implant-related causes of UPROR. MCGR continues to have high complication rates, better knowledge of MCGR outcomes may improve patient education, surgical timing, and decision-making.