Short for MAGnetic Expansion Control, MAGEC is an outstanding innovation in pediatric orthopedic surgery that serves to resolve scoliosis through implantable magnetic rods controlled by an external magnetic remote control, with minimum surgeries and maximum benefits.
What is scoliosis?
An abnormal, sideways curved spine which affects about 10% children as early-onset scoliosis, and is variable in age of onset and severity. In severe cases, it can cause serious physical deformity, a shortened trunk, and ultimately cardiopulmonary problems if left untreated in addition to retarded growth and development, meaning a smaller lifespan.
The most common form of scoliosis is idiopathic i.e. without identified cause or concomitant conditions. Early-onset scoliosis befalls before 5 years, and infantile idiopathic sclerosis before 3 years.
How was it managed?
Previously, we used braces/casts to deal with the problem. Braces were plastic corsets that began below the arms and extended to the hips, could be wrapped around, and were worn underneath clothes over a light shirt for 16 or more hours each day till the child turned 14-16. But bracing did not work beyond 50-60 degrees of spinal deformity for 2 to 7-year-old children, showed a poorer response, and stunted the growth of spine.
Then came traditional growing rods, but they required repeated invasive surgeries for manual lengthening of the rod during the child’s growing years – besides interfering with the normal growth of spine – that increased complication rates and length of hospital stay.
These methods are now outdated, though in mild cases they sometimes even cured scoliosis, or at least bought time for exploration of further options.
What we wanted was to remove the need for repeated trips to the operation theatre, as well as eradicate complications from infections and the psychosocial effects of several surgeries. And as a solution, we’ve embraced new technology to make the lengthening process easier and less painful for children while lessening morbidity.
What is it? MAGEC!
First performed in February 2014, when it was cleared by the FDA (Food and Drug Administration) for use in young patients with severe spinal deformities
linked to – or at risk for – thoracic insufficiency syndrome (a condition whereby the chest is unable to support normal breathing and lung growth thus endangering life), the procedure is as follows: the preliminary surgery requires moving away skin and muscle from the spine and anchors – either hooks or screws – are
placed below the neck and at the lower back part of the spine to which two expandable rods are attached. Having the diameter of a pen, they contain a magnetic motor which is later expanded by an external handheld remote controller positioned at the location of the magnet in the rod at subsequent visits.
These newer rods therefore surpass the traditional ones as orthopedic surgeons can lengthen the rod non-invasively during the child’s treatment course. Occurring every 3-4 months, the procedure only requires about 15 minutes, and can be monitored radiographically.
They’re also better than the former as they allow the spine to grow while simultaneously correcting the curve. And once spinal maturity approaches, the rods are removed so the final step of spinal fusion can be performed.
Consequently, they are effective tools for children whose spinal curvature is too significant to control with bracing or casting i.e. children with severe scoliosis.Though not an end, MAGEC is most definitely a device for bridge treatment spanning the years between primary lengthening and spinal fusion.
Eligibility for MAGEC requires the child to have scoliosis greater than 50 degrees in magnitude and be between 5-10 years. The overwhelming benefit is fewer surgeries and anesthesia, lesser time and pain for kids, plus it also allows the doctor to increase the rod length sooner – at 3 months versus 6 – which is probably more similar to natural spinal growth. Once the deformity is controlled, the chest wall gets sustained and cardiopulmonary problems are averted.
The problem however lies in the fact that children have to stand the physical and psychological burden of experiencing lengthening procedures every 6-12 months until skeletal maturation for spinal fusion, at around 10 years and 12-13 years for girls and boys, respectively. MAGEC also undoubtedly costs money besides time for patients at work and children at school.
Anyhow, MAGEC still stands out as potentially the most effective management procedure for scoliosis. Treating a biological problem with a mechanical solution,it adds to an already vigorous program of minimally invasive devices and inventions that will only continue to increase in the future