The session commenced with the definition of early onset scoliosis and why this type is such a challenge due to skeletal immaturity at presentation. The predominant reason for this is the potential for the spine to continue to grow.
Natural History of Untreated EOS
The session continued with the natural history of untreated EOS leading to thoracic insufficiency syndrome and in the most extreme cases premature death. Relevant factors were discussed including the concepts of peak growth velocity from 0-5 years (DiMeglio et al), alveolar maturation, short T1—T12 segments and distorted thoracic cage motion. In the most extreme circumstances thoracic insufficiency syndrome may manifest which can be lethal in severe cases.
Magnetically Controlled Growing Rods (McGR) for Treatment
Mr Nnadi then explained the option of magnetically controlled growing rods (McGR) and its history in the literature with studies allowing it to be approved by NICE (National institute of Clinical Evidence) in the UK. He went on to discuss recent controversies from the presence of metallosis and the withdrawal of the McGR by the MHRA (pending further information) thus giving a balanced view of a ground-breaking technique.
Overall Goals of Growth-Friendly Devices and Indications for Stopping Lengthening
Dr Yacizi then continued to talk about the overall goals of growth friendly devices and the indications of when to stop lengthening and achieve ‘graduation’ (final goal) and when this should be; Namely, calendar age, biological age or 80% pulmonary maturation. He also described his experience with McGR at graduation and the risk versus benefits of fusion. He highlighted that McGR were generally successful but recent complications and evidence should be taken seriously and analysed.
Summary and Discussion
Dr Helenius then offered a brief summary of discussions and took some questions regarding complex stuff curves.
Overall, this was an excellent and highly enjoyable and informative session.