Magic growing rods
When Emma Sneider was seven years old, her mother Mary discovered that Emma’s spine was not quite where it should be.
Her spine was curved and, as doctors soon confirmed, Emma had scoliosis.
“There are two types of scoliosis. Typically it presents during the peak growing period in teens, however it can also occur earlier in childhood,” says Dr. Parham Rasoulinejad, orthopaedic surgeon at London Health Sciences Centre.
Early onset scoliosis like Emma’s means that the curve in the spine will keep progressing during the teen growth period and it can cause serious disability, even death in some cases. It also becomes harder to correct as it progresses.
The family had several options to consider as best treatment for their daughter.
“We could wait and see how it progressed, but it seemed to us that it was progressing quickly. Other options included an external brace or a growing rod that is inserted into the spine,” says dad Nicholas.
The family opted for the growing rod to help straighten the spine as Emma grows, which meant surgery for their young daughter at Children’s Hospital, LHSC.
Traditionally, the surgeon implants two growing rods, one along each side of the spine. The growing rods have spacers mid rod, and every six months the patient undergoes surgery to lengthen the growing rods by adjusting the spacers to align with their growth.
“There is an emotional toll with multiple surgeries for the child. Typically the first and second surgeries are fine, but then the patient becomes more and more anxious as they anticipate the upcoming surgeries,” says Dr. Rasoulinejad.
A more recent option, called the MAGEC system, consists of magnetically-driven adjustable spinal rods and a non-invasive, external remote control device.
Using the external remote control to lengthen the rods in the patient eliminates the traditional repeat surgeries for lengthening the spinal rods.
In November 2015 Emma was the first patient in Ontario to have these rods implanted by a team of specialists including Dr. Parham Rasoulinejad and Dr. Tim Carey.
“I have had only one surgery in my entire life and that was when I was eight years old,” says Emma, now nine. “I was incredibly scared. I tried to take off the mask but then I just fell asleep.”
Now Emma and her family come in every six to nine weeks to have her spine lengthened. While her mother holds her, Dr. Rasoulinejad activates the remote control device and extends the rods in Emma’s spine by 2 to 3 millimetres each visit. The entire procedure takes about two minutes.
“The main goal is to prevent the progression of curvature but still allow the spine to grow without causing a fusion to occur,” says Dr. Rasoulinejad. “If you put too much pressure on the spine or are too aggressive with the correction and the surgery, the spine can go on to auto-fuse, stopping growth all together.”
The rods will be in Emma until she finishes her peak growth period, likely around the age of 12, and then she may need to undergo a final procedure to permanently fuse the spine.
Eliminating the need for invasive surgeries every six months has many benefits for patients and their families, including decreased hospitalization, reduced exposure to anesthetic, and decreased potential for complications and infection related to surgery.
While the growing rods have already made a tremendous difference in the curvature of Emma’s spine, flexibility is a challenge for her.
“I don’t have complete flexibility. It’s embarrassing at school when we have to put our heads on our desks, and I just can’t do it,” says the Grade 4 student.
While Emma’s surgery was the first in Ontario, many children with early onset scoliosis could be a candidate for this type of growing rod.
“Early onset scoliosis is very rare, so this is not a common procedure. Most specialized centres such as Children’s Hospital at LHSC may do two or three a year and that’s pretty rare,” says Dr. Rasoulinejad.
As for Emma, the surgery hasn’t dampened her enthusiasm for Pokemon and swimming, two of her favorite things.
“Swimming is something that I love to do. I’ll do anything even to swim just for five minutes, and my swimming is better now,” says Emma.
Long term, a youngster with spinal surgery to correct scoliosis may feel some stiffness or reduced range of motion in the areas of her spine, but generally not enough to interfere with everyday activities.
Nicholas and Mary are thankful their daughter was able to have the magnetically-driven adjustable rods to help straighten her spine.
As Nicholas says, “We are very grateful that Emma doesn’t have to go through surgery every few months.”