Children’s Mercy Kansas City is one of only 20 children’s hospitals in the nation selected to participate in the early user group for the MAGEC® (MAGnetic Expansion Control) System.
In early 2015, a seven-year-old became the first patient in Kansas and Missouri to receive a new, ground-breaking treatment for scoliosis, aptly named MAGEC.
To brace the spine and minimize the progression of spinal curvature, the MAGEC system’s magnetic rods are implanted along each side of the spine during a one-time, surgical procedure.
Nigel Price, MD shares more about how MAGEC is transforming pediatric medicine during this segment of Transformational Pediatrics.
MAGEC® Rod System: Minimally Invasive Approach to Pediatric Spinal Care
Featured Speaker:
Learn more about Nigel Price, MD
Nigel Price, MD
Nigel Price, MD, is the Chief of the Section of Spine Surgery at Children's Mercy Kansas City. He is also Associate Program Director Orthopedics, Truman Medical Center, Associate Professor Orthopaedic Surgery, University of Missouri-Kansas City School of Medicine, and Clinical Assistant Professor Orthopaedic Surgery, University of Kansas. Dr. Price received his medical degree from Queen’s University Kingston, Ontario, Canada, and completed residency in orthopaedic surgery at Queen's University/Kingston General Hospital Kingston, Ontario, Canada. In addition, he completed a pediatric orthopaedic surgery fellowship at Adelaide Women and Children's Hospital, Adelaide, Australia, & Hospital for Sick Children, Toronto, Ontario, Canada, as well as a clinical orthopaedic fellowship at Queen's University/Kingston General Hospital Kingston, Ontario, Canada. As a board-certified surgeon, his professional, clinical and research interests include early onset scoliosis, non-operative treatments of scoliosis, and cost effectiveness in spine surgery.Learn more about Nigel Price, MD
Transcription:
MAGEC® Rod System: Minimally Invasive Approach to Pediatric Spinal Care
Dr. Michael Smith (Host): Welcome to Transformational Pediatrics. I’m Dr. Michael Smith. Our topic today is “Magec® Rod System: Minimally Invasive Approach to Pediatric Spinal Care.” My guest is Dr. Nigel Price. Dr. Price is the Chief of the Section of Spine Surgery at Children’s Mercy Kansas City. Dr. Price, welcome to the show.
Dr. Nigel Price (Guest): Thank you for having me.
Dr. Smith: What is the Magec® System?
Dr. Price: The Magec® System is the technology that’s relatively new to the American market. It’s been used in Europe and Asia for several years. It’s a device that’s implanted onto the spine in a child less than 10 years of age with a scoliotic curve over 30 degrees by our method of measuring and who is at risk of continued progression of the curvature. What this device has done is essentially revolutionized the historical treatment of these children’s scoliotic curves in that once it’s implanted, we can remotely lengthen the rod through the skin with an activator rather than the traditional method, which is to bring the child back to the operating room every six months for a surgical lengthening. So, it’s essentially taken away these repeated surgeries and that’s quite a paradigm shift or a revolution.
Dr. Smith: So, let’s review, again, the ideal candidate for the Magec® Rods.
Dr. Price: The ideal candidate for Magec® Rod is a young child less than 10 years of age who’s spine length is less than 22 centimeters, or less than about 10 inches; who’s measurements or scoliosis measurements is greater than 30 degrees; who’s at risk of continued progression of the curve to the point of developing a problem that in our field is called “thoracic insufficiency syndrome”, which is the interference or inability of the rib cage and the lungs to support work breathing because of the presence of a curvature. That’s kind of the cohort or the group of the patients that we treat with Magec®.
Dr. Smith: Let’s talk a little bit about the historical way we used to treat this. You’re talking about maybe a severe curvature in a child and you’re talking about multiple surgeries to correct that.
Dr. Price: That’s correct.
Dr. Smith: What is the common outcome from those surgeries? Did those surgeries work? Were there complications down the line for the child? What do you think?
Dr. Price: So, for generations, surgeons have been challenged with children who presented early with curves; small children presenting early at sometimes a very, very rapid progression of the curve that puts the child at jeopardy for their health for their lifetime. Early attempts at casting and fusing the spine with just bone grafts, evolved into the early versions of what we called “Herrington rods” which were hook rods that suffered from breakages and prominence. Later versions were good; however, they still required multiple returns to the operating room. There’s a concept that we discuss in our field that’s the law of diminishing returns meaning that the longer these rods are in and the more frequent the surgeries, the greater the likelihood of rod breakage or migration, infection, very rarely, a neurological problem and a stiff spine. The outcome, eventually, with these children is that we historically did a final operation which was a very large adult-like operation at the end of a long journey of repeated operations. So, the course was difficult for the family. They were in the hospital at least every six months for their procedures and, if they had a complication, they had what we call an “unscheduled visit to the operating room,” which, of course, would impact their childhood. Of course, it’s a stressor for the child and the family. Magec® has really been a very nice change for that.
Dr. Smith: Sure. So, Dr. Price when you describe it that way, when you think of the history of treating severe curves in children, you’re using words like “transformative” and it really is when you think about what we used to do for these patients. How about this? Can you walk us through what a patient and a family goes through at your clinic with your team from the initial surgery and through the follow-up treatments?
Dr. Price: Yes. The little boy or girl, usually school aged or beyond is the ideal candidate, with a curve, who has a history of progressing to over 30 degrees. In my case, in our practice, there are three surgeons in my group who are trained to do this. Typically, we’d recommend surgery when the curve is approaching 50 degrees; so, quite a large curve at a young age. We would recommend that they have the insertion of the Magec® Rods. Typically, its two rods that are inserted. They are titanium and they have a torpedo like component in the middle of them and they affix to the spine or attach to the spine with, typically, screws or hooks. They come in for their operation and are in the hospital for two or three days. They have a little supportive brace initially and then, they have a follow up, usually just a couple of weeks after to check on their wound. The typical course is that, instead of coming back in six months after the surgery for a lengthening surgically, they come back approximately three months later. They come to the clinic as an outpatient and we use a little device that’s held over the skin in the back. We locate the magnets in their back with a little detector and then, we just position or hover this device--it’s called an “external remote controller”. We push a button. There’s a little noise and they are sometimes aware of a little funny sensation but we don’t typically have to give them pain medicine. It’s a tickle. These days, they’re using their iPad while we’re doing it and smiling. The whole process takes perhaps a minute or two, really, for the actually lengthening. We take an x-ray to confirm that we’ve successfully lengthened it the prescribed amount, usually somewhere in the 1/8 to ½ an inch, and then we discharge them. They come and we do not require any pain medicine and we see them back again in three to six months for their next lengthening. They rarely require a revision, at least in the first three years, to upgrade to a larger device. These devices can typically span the duration that they are needed until they’re old enough to replace them with a permanent rod which happens, typically, over the age of 10.
Dr. Smith: Obviously, we are improving outcomes here because we are decreasing the number of invasive procedures and that’s always good in medicine, right? So, let me just ask the question, how are you improving outcomes? What have you found so far?
Dr. Price: So far, we’ve done about a dozen at Children’s Mercy now and we’ve found that very typically the parental and the patient satisfaction, the level of anxiety that I used to see and that I still see with kids that are doing the conventional treatments, is much less. So, really, from a patient anxiety and anticipation level, we are seeing an improvement. From an economic perspective, the impact on the family, taking time off work, traveling to the hospital, sometimes the patients historically have to stay overnight, if they had other medial issues. That’s really gone. So, the impact to the family and the impact to whoever’s paying that bill is less. Generally, we’re seeing both patient satisfaction and early signs of the economic benefit of this process.
Dr. Smith: What do you think the future of this type of technology is? Does this have application in other conditions? Where do you see this going?
Dr. Price: Absolutely. I think that necessity being the mother of invention that that applies definitely to medicine and medical applications. In fact, there’s a version of this called a “Precise Implant” and it’s used in long bones, femurs, usually the thigh bone, where it’s implanted and, rather than the external frame that’s been used to historically to lengthen femurs, we now have a version of this magnetically driven lengthening device that can be implanted in long bones. So, that’s actually out there. So, there already is a sister component or sister version of this technology. So, remove activation of devices is out there with good success in areas that have sticky problems for clinicians as well as the impact on the family. We can certainly see this in other areas where there’s deficiency in tissue or deficiency in bone length. I think our imagination just needs to be brought to bear. I think there’s a lot of potential for this.
Dr. Smith: Nice. Dr. Price, obviously, this is fascinating stuff and it really is transforming pediatric medicine. Thanks for the work that you’re doing. Good luck, you know, in using your imaginations for this kind of technology in the future. I think you’re spot on. Thanks for coming on the show. You’re listening to Transformational Pediatrics with Children’s Mercy Kansas City. For more information you can go to ChildrensMercy.org. That’s ChildrensMercy.org. I’m Dr. Michael Smith. Thanks for listening.
MAGEC® Rod System: Minimally Invasive Approach to Pediatric Spinal Care
Dr. Michael Smith (Host): Welcome to Transformational Pediatrics. I’m Dr. Michael Smith. Our topic today is “Magec® Rod System: Minimally Invasive Approach to Pediatric Spinal Care.” My guest is Dr. Nigel Price. Dr. Price is the Chief of the Section of Spine Surgery at Children’s Mercy Kansas City. Dr. Price, welcome to the show.
Dr. Nigel Price (Guest): Thank you for having me.
Dr. Smith: What is the Magec® System?
Dr. Price: The Magec® System is the technology that’s relatively new to the American market. It’s been used in Europe and Asia for several years. It’s a device that’s implanted onto the spine in a child less than 10 years of age with a scoliotic curve over 30 degrees by our method of measuring and who is at risk of continued progression of the curvature. What this device has done is essentially revolutionized the historical treatment of these children’s scoliotic curves in that once it’s implanted, we can remotely lengthen the rod through the skin with an activator rather than the traditional method, which is to bring the child back to the operating room every six months for a surgical lengthening. So, it’s essentially taken away these repeated surgeries and that’s quite a paradigm shift or a revolution.
Dr. Smith: So, let’s review, again, the ideal candidate for the Magec® Rods.
Dr. Price: The ideal candidate for Magec® Rod is a young child less than 10 years of age who’s spine length is less than 22 centimeters, or less than about 10 inches; who’s measurements or scoliosis measurements is greater than 30 degrees; who’s at risk of continued progression of the curve to the point of developing a problem that in our field is called “thoracic insufficiency syndrome”, which is the interference or inability of the rib cage and the lungs to support work breathing because of the presence of a curvature. That’s kind of the cohort or the group of the patients that we treat with Magec®.
Dr. Smith: Let’s talk a little bit about the historical way we used to treat this. You’re talking about maybe a severe curvature in a child and you’re talking about multiple surgeries to correct that.
Dr. Price: That’s correct.
Dr. Smith: What is the common outcome from those surgeries? Did those surgeries work? Were there complications down the line for the child? What do you think?
Dr. Price: So, for generations, surgeons have been challenged with children who presented early with curves; small children presenting early at sometimes a very, very rapid progression of the curve that puts the child at jeopardy for their health for their lifetime. Early attempts at casting and fusing the spine with just bone grafts, evolved into the early versions of what we called “Herrington rods” which were hook rods that suffered from breakages and prominence. Later versions were good; however, they still required multiple returns to the operating room. There’s a concept that we discuss in our field that’s the law of diminishing returns meaning that the longer these rods are in and the more frequent the surgeries, the greater the likelihood of rod breakage or migration, infection, very rarely, a neurological problem and a stiff spine. The outcome, eventually, with these children is that we historically did a final operation which was a very large adult-like operation at the end of a long journey of repeated operations. So, the course was difficult for the family. They were in the hospital at least every six months for their procedures and, if they had a complication, they had what we call an “unscheduled visit to the operating room,” which, of course, would impact their childhood. Of course, it’s a stressor for the child and the family. Magec® has really been a very nice change for that.
Dr. Smith: Sure. So, Dr. Price when you describe it that way, when you think of the history of treating severe curves in children, you’re using words like “transformative” and it really is when you think about what we used to do for these patients. How about this? Can you walk us through what a patient and a family goes through at your clinic with your team from the initial surgery and through the follow-up treatments?
Dr. Price: Yes. The little boy or girl, usually school aged or beyond is the ideal candidate, with a curve, who has a history of progressing to over 30 degrees. In my case, in our practice, there are three surgeons in my group who are trained to do this. Typically, we’d recommend surgery when the curve is approaching 50 degrees; so, quite a large curve at a young age. We would recommend that they have the insertion of the Magec® Rods. Typically, its two rods that are inserted. They are titanium and they have a torpedo like component in the middle of them and they affix to the spine or attach to the spine with, typically, screws or hooks. They come in for their operation and are in the hospital for two or three days. They have a little supportive brace initially and then, they have a follow up, usually just a couple of weeks after to check on their wound. The typical course is that, instead of coming back in six months after the surgery for a lengthening surgically, they come back approximately three months later. They come to the clinic as an outpatient and we use a little device that’s held over the skin in the back. We locate the magnets in their back with a little detector and then, we just position or hover this device--it’s called an “external remote controller”. We push a button. There’s a little noise and they are sometimes aware of a little funny sensation but we don’t typically have to give them pain medicine. It’s a tickle. These days, they’re using their iPad while we’re doing it and smiling. The whole process takes perhaps a minute or two, really, for the actually lengthening. We take an x-ray to confirm that we’ve successfully lengthened it the prescribed amount, usually somewhere in the 1/8 to ½ an inch, and then we discharge them. They come and we do not require any pain medicine and we see them back again in three to six months for their next lengthening. They rarely require a revision, at least in the first three years, to upgrade to a larger device. These devices can typically span the duration that they are needed until they’re old enough to replace them with a permanent rod which happens, typically, over the age of 10.
Dr. Smith: Obviously, we are improving outcomes here because we are decreasing the number of invasive procedures and that’s always good in medicine, right? So, let me just ask the question, how are you improving outcomes? What have you found so far?
Dr. Price: So far, we’ve done about a dozen at Children’s Mercy now and we’ve found that very typically the parental and the patient satisfaction, the level of anxiety that I used to see and that I still see with kids that are doing the conventional treatments, is much less. So, really, from a patient anxiety and anticipation level, we are seeing an improvement. From an economic perspective, the impact on the family, taking time off work, traveling to the hospital, sometimes the patients historically have to stay overnight, if they had other medial issues. That’s really gone. So, the impact to the family and the impact to whoever’s paying that bill is less. Generally, we’re seeing both patient satisfaction and early signs of the economic benefit of this process.
Dr. Smith: What do you think the future of this type of technology is? Does this have application in other conditions? Where do you see this going?
Dr. Price: Absolutely. I think that necessity being the mother of invention that that applies definitely to medicine and medical applications. In fact, there’s a version of this called a “Precise Implant” and it’s used in long bones, femurs, usually the thigh bone, where it’s implanted and, rather than the external frame that’s been used to historically to lengthen femurs, we now have a version of this magnetically driven lengthening device that can be implanted in long bones. So, that’s actually out there. So, there already is a sister component or sister version of this technology. So, remove activation of devices is out there with good success in areas that have sticky problems for clinicians as well as the impact on the family. We can certainly see this in other areas where there’s deficiency in tissue or deficiency in bone length. I think our imagination just needs to be brought to bear. I think there’s a lot of potential for this.
Dr. Smith: Nice. Dr. Price, obviously, this is fascinating stuff and it really is transforming pediatric medicine. Thanks for the work that you’re doing. Good luck, you know, in using your imaginations for this kind of technology in the future. I think you’re spot on. Thanks for coming on the show. You’re listening to Transformational Pediatrics with Children’s Mercy Kansas City. For more information you can go to ChildrensMercy.org. That’s ChildrensMercy.org. I’m Dr. Michael Smith. Thanks for listening.