Growing Rods

For some children in the 2-to-10-year-old age range, a device known as a “growing rod” may be utilized. There are several types of growing rods, including a traditional growing rod, a Vertical Expandable Prosthetic Titanium Rib (VEPTR), or a MAGnetic Expansion Control (MAGEC) rod. The decision to use one device over the other depends on several factors, including the curve type and whether any other underlying conditions contribute to the scoliosis.

This correction, without fusing the spine, minimizes any growth stunting that can occur with fusion. This allows not only the spine to grow but also the lungs to mature to their full capacity. All of the rods are placed under general anesthesia.

Because of the stability and effectiveness of the devices used in spine operations today, patients are usually able to walk the day following their surgery, and hospital stays are generally 3-5 days. The majority of children return to school within 4 weeks and can often resume full activity, including sports, within 6 months, if not sooner.

Traditional Growing Rod

In this type of treatment, a metal rod attached to the spine is periodically lengthened by a simple procedure. It is usually attached to the spine at the top, and then to the spine or the hips at the bottom, with the rod in between. Most often, it involves two rods. The difference between this and a full spinal fusion is that there are only screws placed in the spine at the top and the bottom of the rod, and not in between. This allows continued spinal growth.

In the post-operative period, no casting or bracing is necessary, and they can return to full sports after about 6 months. The rods are generally lengthened every 6-9 months, depending on the child's age. The lengthenings take place under general anesthesia. Only a small portion of the incision is used to lengthen the device.

Many children can go home the same day, but this depends on several factors; some children may stay overnight. Many children are able to return to school after a couple of days and resume activities as tolerated.

Titanium Rib (VEPTR)

The VEPTR device differs from the traditional growing rod in that it is attached to the ribs at its top. It is then attached to the spine or the hips on the bottom. The innovation of the VEPTR provided treatment for the infant or child with thoracic insufficiency syndrome.

Thoracic Insufficiency Syndrome has been defined as the inability of the chest to support normal breathing or lung growth. If the chest cannot grow normally, the child’s lungs cannot grow, and life-threatening breathing problems may develop.

The VEPTR has been designed to allow the rib cage to grow while controlling spinal deformity without spinal fusion. Before this technique was developed, there was no effective treatment for the combination of chest wall deformity and scoliosis, which can impair lung growth and pulmonary function.

One or two VEPTR devices are placed, depending on the extent and type of deformity. The initial procedure requires hospital admission for 3-5 days. In the post-operative period, no casting or bracing is necessary, and regular activities are not limited. If the device is attached to the spine at the bottom, kids can return to contact sports after about 6 months.

To keep the rib cage growing, the VEPTR must be lengthened every 6-9 months. The lengthenings take place under general anesthesia. Many children can go home the same day, but this depends on several factors; some children may stay overnight. Many children are able to return to school after a couple of days and resume activities as tolerated. Only a small portion of the incision is used to lengthen the device.

In this special group of children, the VEPTR technique offers real promise in preventing inadequate chest wall growth and, in turn, inadequate lung growth and subsequent breathing problems. We are excited to treat this set of patients and offer a solution that truly changes the prognosis of thoracic insufficiency syndrome.

MAGnetic Expansion Control (MAGEC) system

The MAGEC (MAGnetic Expansion Control) device, which uses external magnets to control a rod implanted in the spine, is for children diagnosed with progressive early-onset scoliosis who have not benefited from nonsurgical treatments. Dr. Michael Vitale performed New York City’s first procedure using this device in a 5-year-old with early-onset scoliosis.

The initial procedure is much like that of the traditional growing rod or VEPTR. It is attached to the ribs or spine at the top of the device, and then to the spine or hips at the bottom of the device. The initial procedure requires hospital admission for 3-5 days.

In the post-operative period, no casting or bracing is necessary, and regular activities are not limited. The majority of children return to school within 4 weeks and can often resume full activity, including sports, within 6 months, if not sooner. If the device is attached to the spine at the top or bottom, kids can return to contact sports after about 6 months.

The main difference between the traditional Growing Rod/VEPTR and the MAGEC is the lengthening device in the middle. In the VEPTR or traditional Growing Rod, the patient must return to the operating room for device lengthening every 6-9 months. With the MAGEC system, the patient can undergo lengthening in the office without anesthesia.

The lengthening will involve placing an external remote controller over the magnet's location, and the rod will lengthen in a matter of minutes. The patient then has an X-ray to confirm the amount of lengthening achieved. There is typically no pain involved during the lengthening. There are no additional incisions or bandages. The child can return to activities immediately, as tolerated.

Lengthenings are typically performed every 3 months, but this can vary depending on the patient’s age and curve. It decreases the risk of infection and the need for anesthesia because the lengthenings are performed without an incision or anesthesia. This has completely changed how we treat a young child with a progressive scoliosis despite conservative treatment.