- Curve progression requiring revision surgery during the spine-lengthening process
- The number of levels spanned with the growing rods
- The duration of treatment
Du et al. report these results without spin in a way that is most useful for surgeons who are considering using these implants in their armamentarium. This is the way all new technology, especially complex advances in surgical care, should be reported.
Orthopaedic implants and instruments continue to evolve, almost always toward more sophisticated digital technology, complex engineering, and more numerous moving parts. The advent of magnetic growing rods for treating early-onset scoliosis is just one example. Often such advances are reported on by surgeons who are conflicted by personal and financial interests in the technology. This leads to all manner of potential bias–indication bias, reporting bias, selection bias, and detection bias to name just a few. Readers should evaluate this type of data with a high degree of suspicion.
What we need throughout orthopaedics are more multicenter, multisurgeon, “deconflicted” cohort studies and clinical trials. When such rigorous studies are conducted to investigate “high-tech” growing rods in patients with early-onset scoliosis, I will not be surprised if researchers find the same risk factors for reoperation after fusion that Du et al. found.
Marc Swiontkowski, MD
JBJS Editor-in-Chief