Unplanned return to the operating room (UPROR) occurs in 40% of MCGR patients at an average of 2years after initial implantation.

Abstract

This study calculated the rates of Unplanned Return to the Operating Room (UPROR) in early-onset scoliosis patients who had no previous spine surgery and underwent Magnetically Controlled Growing Rod (MCGR) implantation. We reviewed surgical, radiographic, and UPROR outcomes for EOS patients treated with the MCGR implant < 12years + 11months of age, had complete preop/postop major curve measurements, and had complete MCGR details. 376 patients underwent MCGR implantation at a mean age of 7.7years (1.8-12.9). Diagnoses included 106 (28%) idiopathic, 84 (22%) syndromic, 153 (41%) neuromuscular, and 33 (9%) congenital. The mean preop-cobb was 76.7° (9-145°), and an immediate postop correction was 41% (0-84%). We found that 38% (142/376) of patients experienced an UPROR prior to the maximal actuator length being achieved. UPROR occurred at mean 2years (3days-5years) after initial implantation. Of the 142 patients who experienced UPROR there were 148 complications that lead to an UPROR. The most common reason for UPROR was anchor (55/148: 37%) or MCGR implant related (33/148: 22%). Wound related (22/148:15%), Neuro related 4/148: 3%), and other (34/148: 23%) accounted for the remaining UPROR occurrences. In conclusion, the MCGR UPROR rate was 142/376 (38%) after an average of 2years post implantation. At 2-year follow-up, only 20% of MCGR patients had experienced an UPROR. However, between 2 and 5years, the development of an UPROR increased precipitously with only 39% of MCGR patients remaining UPROR free at 5years post MCGR implantation. The most common reason for UPROR was related to anchor or MCGR implant-related complications. This information can be utilized to set realistic expectations about the need and timing of future surgical procedures with patients and their families.