Growing Rods for Pediatric Scoliosis
“Growing rods” may be utilized for some pediatric scoliosis cases when the patient is between two and ten years of age. A device referred to as a “growing rod” is a special expandable rod that is attached to the spine and periodically lengthened.
This procedure that allows for correction without fusing the spine minimizes any stunting of growth that sometimes occurs with fusion. This allows growth of not only the spine but also allows the lungs to mature to the full capacity as well. The patient is placed under general anesthesia when the rods are inserted.
Children are typically able to walk only one day after the growing rods have been placed due to the stability and effectiveness of the devices used in spine surgery today. They generally spend approximately 3–5 days in the hospital for recover. The majority of children are able to return to school within 4 weeks. They often return to full activity, including sports, within 6 months or sooner.
Types of Growing Rods
The types of growing rods currently available include 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 such as whether or not there are any other underlying conditions that are contributing to the scoliosis as well as the type of curve.
Traditional Growing Rods
When using traditional growing rods, a metal rod that is attached to the spine is periodically lengthened by a simple procedure. The rod generally runs in between an attachment on the top of the spine and an attachment either lower on the spine or on the hips. It commonly involves the use of two rods. The difference between this procedure 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. After the operation, there is no casting or bracing necessary—the patients can return to their activities and 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 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 go back to activities as tolerated.
The Titanium Rib (VEPTR) Growing Rods
The VEPTR device is different from the traditional growing rods in that the VEPTR device is attached to the ribs at the top of the device. Then, like the traditional growing rods, it is attached to the spine or the hips at the bottom. This important innovation allowed for treatment of the infant or child with Thoracic Insufficiency Syndrome.
Thoracic Insufficiency Syndrome is a condition that involves chest wall deformities. As they grow, the rib cage and spine of these patients cannot keep up with the rate of 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.
Depending on the extent and type of deformity, one or two of the VEPTR devices may be utilized. This surgical procedure requires approximately 3–5 days in the hospital. 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. General anesthesia is required to perform the lengthening. Only a small incision is used for the lengthening process, so many patients can go home the same day. Post-operation recovery 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.
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) rod system
The main difference between traditional growing rods and MAGEC is how it lengthens. In the traditional growing rod, the patient must return to the operating room to have the device lengthened every several months. With the MAGEC system, the rod is lengthened in the office without anesthesia. This is done by placing an external remote control over the location of the magnet and takes only a matter of minutes. The patient then has a x-ray done to confirm the amount of lengthening that was achieved. There are no additional incisions or bandages. The child can get back to activities immediately as tolerated. The rod is typically lengthened every 3–4 months. However, this can vary based on the patient’s age and curve. Avoiding multiple surgeries decreases the chance of infection and the potential risks of repetitive anesthesia.
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.
Resources for Growing Rods information
- MAGEC Insertion vs Serial Lengthenings
- Growing Rods:
Watch the video, below:
Pediatric Orthopaedic Spine Surgery Pre-Op Class