What are MAGEC growing rods?

MAGEC growing rods are part of the MAGEC^TM (MAGnetic Expansion Control) System, a new surgical treatment for children with severe spinal deformities. The system, which includes implantable rods and an external remote control, are used to brace the spine while your child is still growing to minimize the progression of scoliosis.

For a generation, traditional growing rods have been the standard of care for growing children with significant spinal curves that cannot be controlled with bracing or casting, and who are too young for spinal fusion. While effective at managing a child’s scoliosis, growing rods require repeated expansion surgeries to keep pace with the child’s growth. For many children, this means 10 or more spine surgeries before reaching skeletal maturity, and sometimes a final fusion surgery.

Like traditional growing rods, MAGEC rods are surgically implanted initially. But MAGEC rods differ in the way they are expanded; surgery is not needed. Instead, MAGEC rods are lengthened magnetically every three to six months in a short, non-invasive procedure that takes place in a doctor’s office. Most children have two MAGEC rods — on the right and left side of the spine — and each is adjusted individually.

In March 2014, the U.S. Food and Drug Administration approved the MAGEC Spinal Bracing and Distraction System for use in skeletally immature children with severe progressive spinal deformities who had, or were at risk of developing, thoracic insufficiency syndrome. Only a few facilities around the U.S. currently offer this cutting-edge treatment.

MAGEC rods are not appropriate for all children with severe spinal deformities, and are not recommended for very young children or those who have finished growing. MAGEC rods may not be strong enough to lengthen a very stiff curve, so surgeons rarely do conversion operations (taking out growing rods or VEPTR devices and exchanging in MAGEC rods). 

Treatment will depend on your child’s age, size, condition and other factors. If your child has early-onset scoliosis or a related condition, your child’s doctor will discuss treatment options with your family.

Are MAGEC growing rods right for my child?

To be considered for MAGEC growing rods at Children’s Hospital of Philadelphia (CHOP), your child will need to meet certain criteria, including:

• Have significant, progressive scoliosis (generally diagnosed as early-onset scoliosis or idiopathic scoliosis
• Be skeletally immature and have significant bone growth remaining

Depending on your child’s age and development, the physician may study a number of markers to determine how much growth your child has left, including:

• An X-ray of your child’s wrist, hand and fingers, which helps doctors estimate the maturity of your child’s skeletal system (also known as bone age)
• Assessing the stage of bone formation on the edge of the pelvis (known as the “Riser sign”)
• For girls, asking whether menstruation has begun

MAGEC growing rods have not been approved for use in magnetic resonance imaging (MRI) (both the MRI and the MAGEC growing rods are magnets).  If your child gets periodic MRIs as part of their care, MAGEC growing rods may not be a good choice. This contraindication may change in the future.

MAGEC growing rods may be an option for patients who have significant spinal curves that are very likely to worsen and who haven’t responded to preventative bracing.

Evaluation

During your child’s evaluation at Children’s Hospital of Philadelphia, a board-certified pediatric spine surgeon will take your child’s medical history and perform a physical examination of your child. Imaging tests will be performed of the spine to measure the degree of curvature, part of the spine affected, and how best to proceed with surgery.

Imaging tests will include:

• X-rays, which produce images of bones, and show bone placement
• EOS imaging, which produces three-dimensional models from two flat images, and shows your child’s spine in a weight-bearing position

In younger children, an MRI may be used to evaluate the nerves of the spine and spinal cord. These nerves may be abnormal in younger children with scoliosis. An MRI uses a combination of large magnets, radiofrequencies and a computer to produce detailed images of organs, soft tissues and others structures within the body. Your child is exposed to no radiation during an MRI.

In older children, additional X-rays of the hand and hip may be recommended to determine if your child needs a growth-friendly solution to manage their condition until skeletal maturity. If your child has finished growing, another treatment for scoliosis will be recommended.

How is the procedure performed?

Pre-op visit

Before MAGEC growing rod surgery, your child will evaluated by an anesthesiologist and may undergo additional tests.

On the morning of your child’s surgery, you will arrive at the hospital and your child will be admitted. You can stay with your child in the pre-op area until they are ready to go to the operating room.

Your child’s operation will be performed under general anesthesia.

During surgery

MAGEC growing rod surgery at Children’s Hospital is performed by a board-certified orthopedic surgeon who has special training in treating children with spinal deformities.

After your child is administered general anesthesia, surgeons will access the spine from the back. In most cases, two MAGEC rods are inserted — one on either side of your child’s spine — and secured to your child’s spine or ribs by surgical hooks and pedicle screws. In rare cases, a MAGEC rod may be attached to a child’s pelvis.

The rods are attached at two spots — above and below the curve — to brace the spine as your child continues to grow and to minimize the progression of scoliosis.

The variable-length titanium rods have a magnetic component in the middle. During follow-up procedures, this component is activated by an external remote control to expand the rods inside your child without the need for additional surgery. The rods cannot be over-expanded.

Depending on your child’s size and condition, surgery to implant the MAGEC rods will take one to three hours.

Risk and benefits

What are the risks?

While any surgery carries a risk of infection or bleeding, our experience has shown these potential complications are unlikely with MAGEC growing rod surgery.

If your child is extremely active, there is a slightly increased risk your child may need a follow-up procedure to repair weakened or damaged rods, hooks or screws.

After the procedure, your child will have titanium rods and metal instrumentation in their body. While these metal items are in your child’s body, it is essential that you alert any doctor treating your child to this fact — and for your child to avoid MRIs.

If your child needs regular MRIs for another condition, MAGEC growing rods will not be recommended as treatment for your child’s scoliosis.

What are the benefits?

Growing rods — both MAGEC and traditional — greatly benefit children with scoliosis who are still growing. Both devices straighten and stabilize the spine, and allow the child to continue growing.

The benefits of MAGEC rods over traditional growing rods include:

• Fewer surgeries — with MAGEC rods, adjustments can be done in the doctor’s office, not the operating room
• Less anesthesia — fewer surgeries means less need for anesthesia in growing children
• Quicker recovery time after lengthening the rods — this means your child can return to play, school and regular activities sooner

What to expect after surgery

After surgery, your child will be sent to an orthopedic floor or the Pediatric Intensive Care Unit (PICU) based on the recommendation of the anesthesia team. You will be reunited with your child as soon as possible.

Within a day of surgery, your child will get out of bed and walk with the assistance of a nurse or therapist. Your child will receive IV pain medication until they are able to eat and drink, then oral pain medications will be used. Many patients will only need Motrin, a muscle relaxer and other non-narcotic medications.

Before your child is discharged, their incisions will be checked and redressed, and imaging studies – an X-ray or ultrasound – will be taken to ensure the implants are stable.

Most patients are allowed to go home two to three days after the procedure.  

Recovery

Your child will go home walking, climbing stairs, and be able to do most normal activities. Depending on your child’s recovery and pain, they can return to school three to four weeks after surgery. Arrangements can be made with your child’s school so they can keep up with their lessons.

Your child’s incisions will have small surgical strips or a liquid dressing covering them. In most cases, these dressings will eventually curl up and fall off. In some cases, a parent may be instructed to remove these after several weeks.

Normally no bracing or physical therapy is needed after surgery. Your child will be restricted from bending and twisting excessively, as well as gym class and sports, until an orthopedic surgeon evaluates them at a six-week post-operative visit.

Follow-up care

Six weeks after surgery, your child will return to Children’s Hospital for an evaluation by a pediatric spine surgeon.

During this appointment, clinicians will:

• Examine your child’s incision to insure it is healing properly
• Review new X-rays or ultrasounds to ensure the MAGEC implants are positioned correctly and properly bracing your child’s spine for future growth
• Plan and schedule your child’s first lengthening procedure

Most children can return to full activity after this visit and are allowed to participate in sports. There are no major restrictions on activities, but patients are encouraged to avoid activities that carry a greater risk of injury such as trampolines or bungee jumping.

Expansion procedures

Your child’s first expansion procedure will occur about four months after the MAGEC rods are implanted. This non-invasive, outpatient procedure is performed in a private exam room at CHOP. You are encouraged to stay with your child during the procedure, and child life personnel will be on hand to help entertain and distract your child.

In most cases, your child will lay on their belly on the exam table. Younger children may sit on a parent’s lap — with their back facing outward — and hug the parent during the procedure.

A clinician will locate the magnetic component of each rod in your child’s back, and make a small mark on the skin to note the correct placement. Next, the clinician will determine how much to lengthen each rod to match your child’s recent growth (generally 3 to 6 centimeters) and program the external remote controller with the measurement.

The external remote controller is then placed on your child’s back — over the small mark — and activated. Once in position, the external remote controller is turned on and magnetically expands the rod to the pre-determined length. The process is then repeated for the second rod.

Though the procedure is painless and can be completed in less than 10 minutes, some children become anxious when they hear the loud rumbling noise — similar to a washing machine — that the external machine produces. Sedation is not used during the expansion procedure, but if needed, medication can be given to relax your child.

After the lengthening procedure, your child will undergo EOS imaging to ensure the MAGEC rods have been properly expanded and recheck all instrumentation. EOS imaging allows clinicians to see your child’s spine in a weight-bearing position and plan for future expansions.

Your child can return home after the appointment. There are no activity restrictions and your child can return to school the next day.

Your child will continue to be examined — and the MAGEC rods expanded — every three to six months until she finishes growing.

When your child has reached skeletal maturity, a final surgery will be performed to remove the instrumentation and fuse the spine in place.

Rod replacement

Depending on your child’s age and size when the MAGEC growing rods were first implanted, they may need to have the rods replaced before reaching skeletal maturity. If your child is particularly active, rod repair may be needed if a connection between the rods and bones are damaged.

Surgical replacement of MAGEC rods is similar to the initial implant surgery, with the same recovery time and activity restrictions for six weeks after surgery.

Why choose us for MAGEC growing rod surgery?

MAGEC growing rods are innovative surgical devices only available at a few select pediatric hospitals in the United States. Children’s Hospital of Philadelphia offers this cutting-edge surgery to qualified candidates as an alternative to other scoliosis treatments such as:

• Traditional growing rods, which require multiple surgeries over time
• Spinal fusion, an open surgery that locks the spine into position and limits the child’s long-term flexibility

MAGEC growing rod surgery at CHOP is performed by John M. Flynn, MD, an internationally recognized spine surgeon and chief of CHOP’s Orthopedic Center, and Patrick J. Cahill, MD, the nation’s leader in thoracoscopic fusionless spine surgery.

Families considering MAGEC growing rod surgery at CHOP will have access to the Hospital’s multidisciplinary expertise, its patient-focused and family-centered care, as well as one of the nation’s top-ranked pediatric orthopedic programs according to U.S. News & World Report.