Surgical alternatives to casting include growing rods that are lengthened periodically under general anesthesia and a new technique that allows lengthening with an external control.

Story by: Norton Children’s on July 27, 2021

Growing rods and a new, less invasive technique — magnetic rods — offer surgical alternatives for children with early onset scoliosis who don’t respond well to casting and whose curve is likely to get worse as they grow, according to a pediatric orthopedist at Norton Children’s Orthopedics of Louisville, affiliated with the UofL School of Medicine.

Growing rods are placed inside the muscle adjacent to the spine. Because they are only attached to small areas above and below the curve instead of the whole curve, they don’t interfere with the spine’s growth. The rods are lengthened surgically about every six months.

Another, newer approach places telescoping rods surgically attached to the spine like traditional growing rods, but lengthened differently. Using an external magnetic device every few months, the rods are activated to extend 3 to 5 millimeters to keep up with a child’s natural growth rate. The extension is done in the orthopedist’s office and is so slight the child doesn’t feel it.

“Magnetic rods minimize the use of anesthesia and can make it a lot easier for kids and parents,” Dr. Meier said. “The in-office lengthening takes about two to three minutes. You put the controller on the back, find the magnet, push a button and the rod slowly lengthens.”

Magnetic rods can telescope only so far, so they’ll need to be replaced surgically periodically, but not as frequently as growing rods that can’t be lengthened.

“Occasionally very young children with early onset scoliosis of about 20 degrees or so will grow out of it after about a year. But more dramatic curves can get worse, and even mild curves can progress as the child grows,” said Joshua W. Meier, M.D., pediatric orthopedic surgeon with Norton Children’s Orthopedics of Louisville.

Bracing can control the progress of the curve, but isn’t likely to straighten the spine. Special casting techniques used at Norton Children’s Orthopedics of Louisville can straighten the spine, but casting is required for a year or more.

Growing rods have been the standard of care for decades for children who don’t respond to bracing or casting. But the need to lengthen the rods or replace them until the child’s skeletal system matures can mean 10 or more surgeries followed by a spinal fusion operation.