Original Title: Efectividad y seguridad de los tallos electromagnéticos MAGEC. Actualización de la evidencia

Authors' objectives: The objective of this report is to evaluate the effectiveness and safety results of magnetically controlled growing rods in the treatment of early onset scoliosis.

Authors' results and conclusions: Four systematic reviews, 2 health technology evaluation reports and 37 primary articles with a total of 830 patients and an average follow-up period between 2.5 and 49 months were included. Combining the results of the studies through meta-analysis identified that the mean change in Cobb angle from preoperative to immediate postoperative was -24.93º (p < 0.00001); and, from preoperative to final follow-up was -24.79º (p < 0.00001). In addition, the mean change in T1-T12 distance from preoperative to immediate postoperative was 17.41 mm (p < 0.00001); and, from preoperative to final follow-up was 33.55 mm (p < 0.00001). The mean change in distance T1-S1 from preoperative to immediate postoperative was 29.36 mm (p < 0.00001); and, from preoperative to final follow-up was 50.40 mm (p < 0.00001). Furthermore, the mean change in thoracic kyphosis angle from preoperative to immediate postoperative was -8.97º (p < 0.00001); and, from preoperative to final follow-up was -4.73º (p = 0.003). Regarding to respiratory function, the results of one study showed an improvement after the implantation of the electromagnetic rods and in another study no significant differences were observed. Regarding quality of life, the studies provide contradictory data when electromagnetic rods are compared with conventional rods; however, a trend towards improvement with MAGEC rods seems to be reflected in certain domains evaluated according to different scales. The general rate of patients with complications was 43.2 % and the unplanned reoperations of 30.72 %. The three most common complications identified were distraction failures (12.69 %), alterations in the fixations (10.85 %) and rod or screw breakage (8.72 %). CONCLUSIONS Magnetically controlled growing rods provide several advantages by increasing the distance T1-T12 and T1-S1 and decreasing the Cobb angle and thoracic kyphosis. Improvements in the Cobb angle reduction and thoracic kyphosis with magnetically controlled growing rods were predominantly achieved during initial instrumentation and did not change significantly with repeated lengthening, however, thoracic kyphosis presents a worsening in follow-up with respect to postoperative. Magnetically controlled growing rods appear to adhere to the law of diminishing returns since the gain in length T1-S1 achieved after an elongation procedure decreases with a greater number of subsequent distractions. A percentage greater than 40 % of the patients presented complications or required unplanned reoperations, increasing the probability of occurrence over time

Authors' methods: A systematic review and meta-analysis was carried out according to the PRISMA (Preferred Reporting Items for Systematic reviews and Meta-Analyzes) criteria. The databases of MedLine, Embase and Science Citation Index, and health technology evaluation organizations were consulted through a structured search until December 2018. Data on distraction frequency, number of distractions, length of distraction, respiratory function, quality of life, Cobb angle, kyphosis, length of T1-T12 and T1-S1 before and after the intervention, and at the final follow-up were collected. Data were also extracted regarding complications and unplanned reinterventions. To analyse the main results we used a meta-analysis with a random effects elongation procedure decreases with a greater number of subsequent distractions. A percentage greater than 40 % of the patients presented complications or required unplanned reoperations, increasing the probability of occurrence over time.

Project Status: Completed

Year Published: 2020

URL for published report: https://www.aetsa.org/publicacion/efectividad-y-seguridad-de-los-tallos-electromagneticos-magec-actualizacion-de-la-evidencia/

English language abstract: An English language summary is available

Publication Type: Mini HTA

Country: Spain

Organisation Name: Andalusian Health Technology Assessment Area

Contact Address: Area de Evaluacion de Tecnologias Sanitarias Sanitarias de Andalucia (AETSA) Avda. Innovación, s/n Edificio Arena 1. Sevilla (Spain) Tel. +34 955 006 309

Contact Name: aetsa.csalud@juntadeandalucia.es

Contact Email: aetsa.csalud@juntadeandalucia.es

Copyright: Andalusian Agency for Health Technology Assessment (AETSA)