The Problem With Fusing a Young Child's Spine
In a normally developing child, the spine grows from roughly 20 cm at birth to approximately 35 cm by age 10, and to 45 cm by skeletal maturity. This growth is not uniform — the thoracic spine accounts for much of the early gain, and it is functionally linked to thoracic cage expansion and lung development.
A child whose thoracic spine is fused at age 5 will have a shorter trunk and, more significantly, a thoracic cage that cannot grow proportionally with the lungs' demand for capacity. This is the driving problem behind growth-friendly surgery: how do we control a severe spinal curve in a young child while allowing the spine and thorax to grow?
A child fused too early gains a straight spine and loses a chest that can breathe. The goal of growth-friendly surgery is to refuse that trade-off.
Who Needs a Growth-Friendly Construct?
Growth-friendly implants are indicated for children who:
- Are under age 10 (or have significant growth remaining by skeletal maturity assessment)
- Have a curve at or above 50° that is progressing beyond what casting or bracing can control
- Have a diagnosis where curve progression is expected to continue (congenital scoliosis, neuromuscular scoliosis, EOS)
- Have not responded to prior non-surgical management
Infantile idiopathic scoliosis that responds to casting does not typically require surgical instrumentation. The decision to proceed with a growing construct is made only when non-surgical options have been exhausted or are clearly insufficient.
Magnetically Controlled Growing Rods (MCGR): Our Primary Tool
At Central Ortho & Spine, MCGR (MAGEC system) is our principal growth-friendly technique for early onset scoliosis. The construct involves bilateral titanium rods anchored to the spine above and below the curve. The initial surgery typically takes 2.5–4 hours under general anaesthesia, with a 3–4 day hospital stay.
What makes MCGR transformative compared to its predecessors is the lengthening mechanism. A small actuator within each rod responds to an external magnetic field applied in clinic. Lengthening takes approximately 5 minutes per rod, requires no anaesthesia, and causes only mild discomfort — comparable to physiotherapy. We typically lengthen every 3–4 months, with the goal of maintaining the spine's growth trajectory within a controlled range rather than maximising rod length at each session.
What Families Experience
The reality of living with a growing construct requires honest discussion. Families should understand:
- This is a bridge, not a destination. MCGR is designed to manage the curve until the child is old enough (typically late teens) for definitive posterior fusion. The total treatment course typically spans 8–12 years from first implant to final fusion.
- International follow-up is manageable. Lengthening can be performed at partner centres in most European and Gulf countries. Annual clinical reviews at our Istanbul centre are recommended; for stable cases, we review remotely in alternate years.
- Complications exist. Rod fracture, implant migration, wound infection, and auto-fusion (spontaneous bony bridging that limits rod travel) are recognised complications. Our centre's complication rate aligns with international published data; we discuss each complication category specifically with families during consent.
- Activity restrictions are moderate. Children with MCGR rods can typically attend school, swim, cycle, and participate in non-contact sport. We advise against contact sports and gymnastics, though compliance monitoring in this age group is a practical challenge.
When MCGR Is Not the Right Choice
MCGR works best in flexible, non-rigid curves. In highly rigid deformities, particularly those from congenital fusions or long-standing neuromuscular scoliosis, the rods may not achieve meaningful correction and complications related to implant stress are higher. In these cases, VEPTR or hybrid techniques combining short segmental fusion with distraction may be more appropriate.
There is also a category of patients — particularly those with SMA, DMD, or other conditions where surgery carries elevated risk — where the timing question requires careful multidisciplinary discussion. We do not approach these cases unilaterally; pulmonology, neurology, and paediatric anaesthesia are involved in the planning of every complex MCGR case.
Outcomes We See
In children treated with MCGR at our centre, the majority achieve meaningful initial curve correction at the time of implantation (typically 40–60% reduction from pre-operative Cobb angle) and maintain curve control during the distraction phase. Thoracic height gain correlates with the predicted natural growth trajectory in the majority of cases, which we monitor on annual standardised EOS imaging.
At the time of conversion to final fusion, most patients have curves in the 30–50° range — a far better starting point for fusion than the 60–80° curves we would expect had growth-friendly management not been employed.
Starting the Conversation
If your child has been diagnosed with early onset scoliosis and you are considering whether a growing construct might be appropriate, we are glad to review prior imaging remotely and provide a written opinion before you travel. Understanding the full arc of treatment — from initial implant through lengthening to final fusion — before committing is important, and we take that preparation seriously.