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Two stage posterior surgery using temporary Magnetically Controlled Growing Rod for severe and rigid Adolescent
Mauro Spina1, Enrico Salvatore D'Agostino2, Roberto Giuliani3,2
1Regional Spinal Department, University and Hospital Trust, Verona, Italy.
Introduction:
To evaluate clinical and radiographic outcomes in patients with severe, rigid Adolescent Idiopathic Scoliosis (AIS) (Cobb angle >100°, flexibility index <30 %) treated using a two-stage posterior-only approach with temporary Magnetically Controlled Growing Rods (MCGR).
Material And Methods:
Between 2019 and 2024, nine patients (eight Lenke 1, one Lenke 3; mean age 15 years; BMI 18.8) underwent staged posterior correction. The first stage included high-density pedicle screw fixation (1.92 screws/vertebra), multiple Ponte osteotomies (mean 4.7), and placement of a concave-side MCGR fixed proximally and distally with a custom construct ("Sistema Quadro"). Postoperative distraction was performed daily for approximately 14 days using an External Remote Controller, achieving a mean rod lengthening of 18.2 mm. The second stage consisted of MCGR removal and definitive posterior spinal fusion.
Results:
The main Cobb angle improved from 107.6° to 35.4° (p < 0.0001), corresponding to a mean correction of 65.9 %, obtained in three phases: intraoperative distraction (52.5 %), postoperative lengthening (24.5 %), and final fusion (23 %). Trunk height increased by 9.5 cm and thoracic height by 5.4 cm. Coronal balance improved (25.7 mm-14.4 mm; p = 0.32), as did the clavicle angle (4.4°-0.8°; p = 0.0005). SRS-22 scores rose from 3.3 to 4.4 (p = 0.0011). An inverse correlation was observed between BMI and rod lengthening (PCC = -0.7304; p = 0.026). No complications occurred.
Discussion And Conclusions:
A two-stage posterior technique utilizing temporary MCGRs, combined with the "Sistema Quadro" construct and a three-phase correction strategy, offers a safe, effective, and well-tolerated surgical approach for severe, rigid AIS. This method facilitates gradual, controlled deformity correction, optimizes clinical and radiographic outcomes, and minimizes perioperative complications.
