For some children in the 2-10 year-old age range, a device known as a “growing rod” may be utilized. There are several types of growing rods including a traditional growing rod, a Vertical Expandable Prosthetic Titanium Rib (VEPTR), or a MAGnetic Expansion Control (MAGEC) rod. The decision to use one type of device over the other depends on several things including the curve type and if there are any other underlying conditions that are contributing to the scoliosis.
This correction without fusing the spine minimizes any stunting of growth that can occur with fusion. This allows growth of not only the spine but also allows the lungs to mature to the full capacity as well. All of the rods are placed under general anesthesia. Because of the stability and effectiveness of the devices used in spine operations today, patients are usually able to walk the day following their surgery, and hospital stays are generally 3-5 days. The majority of children return to school within 4 weeks and can often return to full activity including sports within 6 months if not sooner.
Traditional Growing Rod
In this type of treatment a metal rod attached to the spine is periodically lengthened by a simple procedure. It is usually attached to the spine on the top and then either attached to the spine or the hips on the bottom with the rod in between. Most often it involves two rods. The difference between this and a full spinal fusion is that there are only screws placed in the spine at the top and the bottom of the rod and not in between. This allows continued growth of the spine. In the post-operative period there is no casting or bracing necessary and they can return to full sports after about 6 months. The rods are generally lengthened every 6-9 months depending on the age of the child. The lengthenings take place under general anesthesia. Only a small portion of the incision is used to lengthen the device. Many children can go home the same day but this depends on several factors and some children stay overnight. Many children are then able to return to school after a couple of days and back to activities as tolerated.
The Titanium Rib (VEPTR)
The VEPTR device is different from the traditional growing rod in that it is attached to the ribs at the top of the device. It is then attached to the spine or the hips on the bottom. The innovation of the VEPTR provided treatment for the infant or child with thoracic insufficiency syndrome.
Thoracic Insufficiency Syndrome has been defined as the inability of the chest to support normal breathing or lung growth. If the chest cannot grow normally, the child’s lungs cannot grow and life threatening breathing problems may develop. The VEPTR has been designed to allow the rib cage to grow while controlling spinal deformity without fusion of the spine. Before this technique was developed, there was no effective treatment for the combination of chest wall deformity and scoliosis that created problems with lung growth and pulmonary function.
One or two of the VEPTR devices are placed depending on the extent and type of deformity. The initial procedure requires admission to the hospital for 3-5 days. In the post-operative period there is no casting or bracing necessary and regular activities are not limited. If the device is attached to the spine at the bottom of the device, then kids get back to contact sports after about 6 months. To keep the rib cage growing, the VEPTR must be lengthened every 6-9 months. The lengthenings take place under general anesthesia. Many children can go home the same day but this depends on several factors and some children stay overnight. Many children are then able to return to school after a couple of days and back to activities as tolerated. Only a small portion of the incision is used to lengthen the device.
In this special group of children, the VEPTR technique offers real promise in preventing inadequate growth of the chest wall and thus inadequate growth of the lung and subsequent breathing problems. We are excited to be able to treat this set of patients, to offer a solution that truly changes the prognosis of thoracic insufficiency syndrome.
MAGnetic Expansion Control (MAGEC) system
The spine center at the NewYork Presbyterian Morgan Stanley Children’s Hospital is unique in New York in offering this new and exciting treatment for the young child with scoliosis. Please follow this link to learn more about MAGEC.
- Growing Rods: