The magnetically controlled growing rod (MCGR) system allows growth maintenance without the risk of anaesthesia, implant and wound complications associated with repeated surgeries. This is a medium-term report of the complications of MCGR from a multicentre study.

Twenty-six patients from 6 spine institutes that are part of a multicentre study with prospectively collected data of minimum 24 months follow-up were assessed. Pre-operative, immediate post-operative and most recent spine radiographs were reviewed to measure the Cobb angle and the rod lengthening distance. The causes and any associated risk factors for re-operations were examined.

Eleven patients required re-operation within the follow-up period, with a mean time to re-operation of 17 months after the initial surgery. Five were due to failure of rod distractions; 3 were due to failure of proximal foundation implants; 2 were due to rod breakage; and one case of superficial wound infection with failure of proximal fixation. Proximal junctional kyphosis occurred in 5 patients. Three had proximal anchor dislodgement and all five constructs were revised.

This is the largest series with the longest follow-up to date. Our series show that the perception that using MCGR may reduce the frequency of re-operations may not be entirely true. This is the first report to examine the need for re-operation after MCGR implantation, and highlights the inherent risks of any surgical treatment in this group of patients despite the advantages of this new implant. Longer-term studies and comparisons with traditional growing rods are required.

Introduction

The potential structural effect of the sacral tilt on the development of disc wedging adjacent to lowest instrumented vertebra (LEV), and consequent postoperative coronal trunk decompensation in the surgical treatment of idiopathic scoliosis are well known. The aim of this study is firstly to establish the possible role of sacral tilt, limb length inequality, and associated pelvic girdle anomalies in the cause of idiopathic scolisosis, and secondly to determine the effect of sacral tilt on adjacent disc wedging below LEV in some idiopathic curves such as thoracolumbar/lumbar curves, and double major curves postoperatively.

Introduction: After the introduction of MRI in routine diagnostic work-up, Split cord malformations (SCM) in patients with Congenital spinal deformities (CSD) is more easily diagnosed and probably overtreated.

Aim: To evaluate the necessity of neurosurgical management of SCM before corrective spinal surgery.

Study Design: Retrospective case series

Patients and Methods: Thirty-two patients aged 11 years + 8 months (4–18 years) with CSDs with a follow up of 51,7+/−26,6 months were analyzed. SCM were classified as Type I(septum dividing the spinal cord and dura into two separate hemicords) and Type II(two hemicords within single dura) according to Pang. Eighteen patients with type I underwent neurosurgical intervention (spur excision and creating a single dural cuff) before corrective surgery (15 sequential and 3 simultaneous). Fourteen patients with type II were treated with posterior instrumentation without dealing with the intraspinal abnormalities. The basic maneuvers were translation, compression and shortening to realign spinal column, avoiding distraction forces and intrusion of any instrument into the spinal canal around anomalous segments. Neurological monitoring was done by the wake-up test.

Results: At final follow up, scoliosis improved from 65,7+/−22 to 37+/−15 degrees (45%) in type I and from 74,3+/−21,8 to 39,4+/−18,7 degrees (47%) in type II. The correction loss was 2,3 degrees in patients with type I SCM and 2,9 degrees in patients with type II SCM. One patient with type I SCM had paraparesis resulting from a misplaced upper thoracic pedicle screws with total recovery after revision. Another patient with type I SCM who had simultaneous surgeries had deterioration of her preoperative neurological deficit only to recover partially. Two patients with type I SCM and one patient with type II SCM developed deep wound infections and needed multiple debridements. Two patients with type I SCM had dural leakage that needed repair.

Conclusion: Although it is a common practice to operate all SCMs before corrective surgery in CSD, it may not be necessary in type II which can be managed safely without any neurosurgical intervention.