Hiroko Matsumoto1,2, Rishi Sinha3, Benjamin D Roye3,4, Jacob R Ball3, Kira F Skaggs3, Jaysson T Brooks5, Michelle C Welborn6, John B Emans7, Jason B Anari8, Charles E Johnston5, Behrooz A Akbarnia9,10, Michael G Vitale3,4, Robert F Murphy11. 1. Department of Orthopedic Surgery, Columbia University Irving Medical Center, New York, NY, 10032, USA. hm2174@cumc.columbia.edu. 2. Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, 10032, USA. hm2174@cumc.columbia.edu. 3. Department of Orthopedic Surgery, Columbia University Irving Medical Center, New York, NY, 10032, USA. 4. Division of Pediatric Orthopaedic Surgery, New York-Presbyterian Morgan Stanley Children's Hospital, Columbia University Irving Medical Center, New York, NY, 10032, USA. 5. Scottish Rite for Children/UT-Southwestern, Dallas, TX, 75219, USA. 6. Department of Orthopaedic Surgery, Shriner's Hospital for Children Portland, Portland, OR, 97229, USA. 7. Department of Orthopedic Surgery, Boston Children's Hospital, Boston, MA, 02115, USA. 8. Division of Orthopaedics, Children's Hospital of Philadelphia, Philadelphia, PA, 19104, USA. 9. San Diego Spine Foundation, San Diego, CA, 92121, USA. 10. Department of Orthopaedic Surgery, University of California San Diego School of Medicine, La Jolla, CA, 92093, USA. 11. Department of Orthopaedics, Medical University of South Carolina, Charleston, SC, 29492, USA.
Abstract
PURPOSE: The purpose of this study was to describe contraindications to the magnetically controlled growing rod (MCGR) in patients with early onset scoliosis (EOS) by establishing consensus amongst expert surgeons who treat these patients frequently. METHODS: Nine pediatric spine surgeons from an international EOS study group participated in semi-structured interviews via email to identify factors that influence decision making in the use of MCGR. A 39-question survey was then developed to specify these factors as contraindications for MCGR-these included patient age and size, etiology, medical comorbidities, coronal and sagittal curve profiles, and skin and soft tissue characteristics. Pediatric spine surgeons from the EOS international study group were invited to complete the survey. A second 29-item survey was created to determine details and clarify results from the first survey. Responses were analyzed for consensus (> 70%), near consensus (60-69%), and no consensus/variability (< 60%) for MCGR contraindication. RESULTS: 56 surgeons of 173 invited (32%) completed the first survey, and 64 (37%) completed the second survey. Responders had a mean of over 15 years in practice (range 1-45) with over 6 years of experience with using MCGR (range 2-12). 71.4% of respondents agreed that patient size characteristics should be considered as contraindications, including BMI (81.3%) and spinal height (84.4%), although a specific BMI range or a specific minimum spinal height were not agreed upon. Among surgeons who agreed that skin and soft tissue problems were contraindications (78.6%), insufficient soft tissue (98%) and skin (89%) to cover MCGR were specified. Among surgeons who reported curve stiffness as a contraindication (85.9%), there was agreement that this curve stiffness should be defined by clinical evaluation (78.2%) and by traction films (72.3%). Among surgeons who reported sagittal curve characteristics as contraindications, hyperkyphosis (95.3%) and sagittal curve apex above T3 (70%) were specified. Surgeons who indicated the need for repetitive MRI as a contraindication (79.7%) agreed that image quality (72.9%) and not patient safety (13.6%) was the concern. In the entire cohort, consensus was not achieved on the following factors: patient age (57.4%), medical comorbidities (46.4%), etiology (53.6%), and coronal curve characteristics (58.9%). CONCLUSION: Surgeon consensus suggests that MCGR should be avoided in patients who have insufficient spinal height to accommodate the MCGR, have potential skin and soft tissue inadequacy, have too stiff a spinal curve, have too much kyphosis, and require repetitive MRI, particularly of the spine. Future data-driven studies using this framework are warranted to generate more specific criteria (e.g. specific degrees of kyphosis) to facilitate clinical decision making for EOS patients. LEVEL OF EVIDENCE: Level V-expert opinion.
PURPOSE: The purpose of this study was to describe contraindications to the magnetically controlled growing rod (MCGR) in patients with early onset scoliosis (EOS) by establishing consensus amongst expert surgeons who treat these patients frequently. METHODS: Nine pediatric spine surgeons from an international EOS study group participated in semi-structured interviews via email to identify factors that influence decision making in the use of MCGR. A 39-question survey was then developed to specify these factors as contraindications for MCGR-these included patient age and size, etiology, medical comorbidities, coronal and sagittal curve profiles, and skin and soft tissue characteristics. Pediatric spine surgeons from the EOS international study group were invited to complete the survey. A second 29-item survey was created to determine details and clarify results from the first survey. Responses were analyzed for consensus (> 70%), near consensus (60-69%), and no consensus/variability (< 60%) for MCGR contraindication. RESULTS: 56 surgeons of 173 invited (32%) completed the first survey, and 64 (37%) completed the second survey. Responders had a mean of over 15 years in practice (range 1-45) with over 6 years of experience with using MCGR (range 2-12). 71.4% of respondents agreed that patient size characteristics should be considered as contraindications, including BMI (81.3%) and spinal height (84.4%), although a specific BMI range or a specific minimum spinal height were not agreed upon. Among surgeons who agreed that skin and soft tissue problems were contraindications (78.6%), insufficient soft tissue (98%) and skin (89%) to cover MCGR were specified. Among surgeons who reported curve stiffness as a contraindication (85.9%), there was agreement that this curve stiffness should be defined by clinical evaluation (78.2%) and by traction films (72.3%). Among surgeons who reported sagittal curve characteristics as contraindications, hyperkyphosis (95.3%) and sagittal curve apex above T3 (70%) were specified. Surgeons who indicated the need for repetitive MRI as a contraindication (79.7%) agreed that image quality (72.9%) and not patient safety (13.6%) was the concern. In the entire cohort, consensus was not achieved on the following factors: patient age (57.4%), medical comorbidities (46.4%), etiology (53.6%), and coronal curve characteristics (58.9%). CONCLUSION: Surgeon consensus suggests that MCGR should be avoided in patients who have insufficient spinal height to accommodate the MCGR, have potential skin and soft tissue inadequacy, have too stiff a spinal curve, have too much kyphosis, and require repetitive MRI, particularly of the spine. Future data-driven studies using this framework are warranted to generate more specific criteria (e.g. specific degrees of kyphosis) to facilitate clinical decision making for EOS patients. LEVEL OF EVIDENCE: Level V-expert opinion.
Authors: Hazeem B Elsebai; Muharrem Yazici; George H Thompson; John B Emans; David L Skaggs; Alvin H Crawford; Lawrence I Karlin; Richard E McCarthy; Connie Poe-Kochert; Patricia Kostial; Behrooz A Akbarnia Journal: J Pediatr Orthop Date: 2011 Jan-Feb Impact factor: 2.324
Authors: Ron El-Hawary; Amer Samdani; Jennie Wade; Melissa Smith; John A Heflin; Joshua W Klatt; Michael G Vitale; John T Smith Journal: J Pediatr Orthop Date: 2016-12 Impact factor: 2.324
Authors: Paul D Sponseller; George H Thompson; Behrooz A Akbarnia; Sergio A Glait; Marc A Asher; John B Emans; Harry C Dietz Journal: Spine (Phila Pa 1976) Date: 2009-07-15 Impact factor: 3.468
Authors: Behrooz A Akbarnia; Lee M Breakwell; David S Marks; Richard E McCarthy; Alistair G Thompson; Sarah K Canale; Patricia N Kostial; Anant Tambe; Marc A Asher Journal: Spine (Phila Pa 1976) Date: 2008-04-20 Impact factor: 3.468
Authors: Paul D Sponseller; Muharrem Yazici; Constantine Demetracopoulos; John B Emans Journal: Spine (Phila Pa 1976) Date: 2007-09-01 Impact factor: 3.468