Balsano Massimo, Spina Mauro
Department of Orthopedics and Traumatology, Azienda Ospedaliera Universitaria Integrata of Verona, Verona, Italy.
Int J Spine Surg. 2020 Oct;14(5):847-851. doi: 10.14444/7094. Epub 2020 Aug 25.
The treatment of early-onset scoliosis with magnetic growing rods has been established, but the management at the end of the lengthening program is still controversial. The options available are removal of rods and observation, removal of rods and immediate fusion, or replacement/maintenance of rods. We present 2 cases of early-onset scoliosis patients treated with Magec rods, up to skeletal maturity. In the first case of a Lenke 3 scoliosis (14 years and 11 months) with a thoracic curve of 50° and lumbar curve of 40°, we removed the rods and kept the patient under observation. After 5 months, the patient showed curve progression, with a thoracic curve of 61° and a lumbar curve of 57°. Consequently, we performed an instrumented T4 to L4 fusion with a correction of the thoracic curve of 66% and lumbar curve of 60%. In the second case of a Lenke 1 scoliosis (15 years and 10 months) with a thoracic curve of 38°, the rods were removed and the patient was kept under observation. After 10 months, following a curve progression, presenting a thoracic curve of 72°, we performed an instrumented fusion T5 to L2 and right thoracoplasty (6 to 11 ribs) with a 40% curve correction. Observing these 2 cases at the end of the treatment with Magec rods, even in case of a good and satisfying final correction, skeletal maturity, and secondary sexual characteristics, we recommend immediate instrumented spine fusion.
使用磁性生长棒治疗早发性脊柱侧弯已得到确立，但延长程序结束时的处理仍存在争议。现有的选择包括取出棒并观察、取出棒并立即融合，或更换/保留棒。我们报告2例使用Magec棒治疗直至骨骼成熟的早发性脊柱侧弯患者。第一例为Lenke 3型脊柱侧弯（14岁11个月），胸弯50°，腰弯40°，我们取出棒并对患者进行观察。5个月后，患者出现侧弯进展，胸弯61°，腰弯57°。因此，我们进行了T4至L4的器械辅助融合，胸弯矫正66%，腰弯矫正60%。第二例为Lenke 1型脊柱侧弯（15岁10个月），胸弯38°，取出棒并对患者进行观察。10个月后，出现侧弯进展，胸弯达72°，我们进行了T5至L2的器械辅助融合及右侧胸廓成形术（第6至11肋），侧弯矫正40%。观察这2例使用Magec棒治疗结束时的情况，即使最终矫正效果良好且令人满意、达到骨骼成熟并出现第二性征，我们仍建议立即进行器械辅助脊柱融合。
