Ahead of the curve

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WIll Imbus is an active 9-year-old with early-onset scoliosis. A new treatment for the condition keeps him on top of his game.

New technology reduces surgeries for young scoliosis patients

By Catie Malooly

Telling an energetic 9-year-old he can’t play baseball or run around with his friends at recess isn’t easy. Delivering that message multiple times a year is even harder.

Will Imbus, a sports fanatic from East Dubuque, Ill., with a quick wit and bright smile, has heard this for the past four years because he has early-onset scoliosis (EOS), an abnormal, side-to-side curvature of the spine. It occurs in children under 5 years old; Will was diagnosed at just 9 months old.

Left untreated, the curve can impede lung growth and development.

“The most important time for lung development is the first four years of life,” says Stuart Weinstein (’72 MD, ’76 R), the Ignacio V. Ponseti Chair and professor of orthopaedic surgery and pediatrics in the University of Iowa Carver College of Medicine. “If their spine is shortened because of scoliosis or if their chest wall is deformed, their lungs don’t reach full development. These are the type of children who can die early because of scoliosis.”

The traditional treatment for EOS requires titanium rods to be surgically implanted into the back across the spinal curvature. Every six months, surgeons reopen the incision site and lengthen the rods to keep up with the child’s growth. Will has undergone seven major surgeries since he was 5 to lengthen his growing rods. Each time has meant pain and restricted activity.

“It causes tremendous stress in the life of a child and the family,” says Weinstein. “Plus, it (an inpatient surgery) means a few days off from work for parents and some time off from school for the child. There are also a lot of costs associated with having an operation every six months.”

Since the 1980s, there have been various attempts to improve the technology of traditional growing rods, but none eliminated the need for recurring surgeries. Additionally, according to Weinstein, roughly 30 percent of children with traditional growing rods experience complications, mostly associated with the delicate fixation points. If a screw in the anchor becomes loose or gets knocked out, for example, that adds a surgery for the child.

“You’re only fusing the top and bottom anchors, leaving everything in the middle so you can stretch it out,” says Weinstein. “And because of that, and because of the normal activities of childhood, the wear and tear on these implants—which are not supposed to last a lifetime—is pretty high.”

MAGEC rods

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A new procedure that implants adjustable rods in the back of scoliosis patients helps correct the curve with fewer surgeries.

Fortunately, repeat surgeries for Will and other EOS patients are becoming a thing of the past.

The MAGEC (MAGnetic Expansion Control) Spinal Growing Rod, developed by Ellipse Technologies Inc., is an adjustable rod that utilizes innovative magnet technology and a remote control to non-invasively lengthen the device. While the MAGEC rod has been used in Europe and elsewhere for a number of years, the Food and Drug Administration only approved the technology for use in the United States in February 2014.

In January 2015, UI Children’s Hospital became the only hospital in Iowa to provide this newly available technology to all EOS patients.

Like traditional growing rods, MAGEC rods are anchored to two foundation sites, toward the top and bottom of the spine. Once surgically inserted, each rod is distracted and bent the desired amount and secured to the spine. Rather than requiring further surgery twice a year to lengthen the rods, MAGEC rods can be lengthened in an outpatient setting, with an external remote controller non-invasively manipulating a rare-earth magnet in the rod until it reaches the appropriate length.

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MAGEC (MAGnetic Expansion Control) Spinal Growing Rod

In addition to correcting the spine curvature and creating more available space for lung growth, this new technology will eliminate six to 10 surgical procedures for most children with EOS.

“The real beauty of the rods is the fact that instead of having multiple operations, children have one operation to implant them, and then they come to the clinic as an outpatient, have the rods lengthened, and go home without any surgery and go back to full activities the same day,” says Weinstein.

Will underwent surgery to implant the MAGEC rods in March 2015. After wearing a temporary brace for three months to protect his incision site, he had his first outpatient lengthening procedure in June. He will continue to return every three to four months for lengthenings, and he will have another major surgery to replace the MAGEC rods with permanent rods when he has finished growing.

External Remote Controller
An external remote controller non-invasively manipulates a rare-earth magnet in the rods in a patient’s back.

Weinstein and his team—who care for almost all of the state’s pediatric spinal deformity patients—are replacing traditional growing rods with MAGEC rods in all of their EOS patients.

Because the technology is so new in the United States, it is yet to be seen if there will be fewer complications in EOS patients with MAGEC rods. Surgeons also need to determine the ideal frequency of lengthening procedures. Despite the few unknowns, feedback so far from patients who have received MAGEC rods, as well as their families, has been overwhelmingly positive.

“I wasn’t quite sure how we or he would handle the rest of these surgeries every six months until we got to the point of the permanent rods,” says Will’s mother, Nicole. “Now, I don’t think there’s anything I could say great enough to show my gratitude.”

Leaders in spinal deformity research

By Catie Malooly

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Stuart Weinstein

Stuart Weinstein, MD, the Ignacio V. Ponseti Chair and professor of orthopaedic surgery and pediatrics at the University of Iowa Carver College of Medicine, has devoted his career to following patients with adolescent idiopathic scoliosis (AIS) throughout childhood, adolescence, and adulthood.

“The research we’ve done over the years in spinal deformities has now given parents the fundamental information they need to make intelligent decisions about their children, because we’ve defined the natural history of the condition,” says Weinstein.

In 2013, Weinstein and Lori Dolan, PhD, a research scientist in the UI Department of Orthopaedics and Rehabilitation, published a study in the New England Journal of Medicine comparing the risk of curve progression in patients with AIS who wore a brace with patients who did not. Though bracing had been used as a treatment for curvature of the spine since 1948, there was no literature proving its effectiveness. The National Institutes of Health ended the clinical trial early after finding that bracing significantly reduced the risk of curve progression and need for surgery.

Additionally, Weinstein and Dolan’s 2003 landmark paper published in the Journal of the American Medical Association defined the lifetime natural history of untreated AIS. Their collective research works over the last 39 years—which defined the evidence base for the prognosis and management of AIS—was selected as the winner of the prestigious 2015 Orthopaedic Research and Education Foundation Clinical Research Award, the highest award in orthopedic clinical research given in the United States.

“We’re one of the leaders in spinal deformity research in children,” says Weinstein. “That has changed medicine, changed lives, and changed care.”