A 'growth-friendly implant' is a temporary spinal device used in the management of 'early-onset scoliosis (EOS)' that permits continued spinal and thoracic growth while controlling deformity. Unlike definitive spinal fusion, these systems aim to stabilize curvature without halting skeletal development.

• Designed for 'children with immature spines'
• Allows for 'incremental lengthening' over time
• Intended for use 'prior to final spinal fusion'
• Helps preserve 'lung development and height potential'

• Traditional Growing Rods (TGR)
• Magnetically Controlled Growing Rods (MCGR, e.g., MAGEC)
• Vertical Expandable Prosthetic Titanium Rib (VEPTR)
• Shilla Growth Guidance System

To control progressive spinal curvature in EOS while maintaining spine and thoracic growth, delaying or avoiding early definitive fusion.

In a registry-based comparative cohort study (early onset scoliosis patients after implant removal) Matan S Malka et al. from the Morgan Stanley Children’s Hospital (Columbia Univ, New York). Arkansas Children’s Hospital; Shriners Philadelphia; Seattle Children’s Hosp. published in Spine Deformity Journal, to evaluate if re-implanting growth-friendly constructs within 12 months after implant removal (ROI) stabilizes deformity compared to observation-only. Early re-implantation (< 12 mo post-ROI) significantly reduces 2‑year coronal Cobb progression compared to no replacement ¹⁾.

- Strengths:

Multicenter registry with well-defined exposure groups.

Radiographic outcomes measured at a meaningful 2‑year follow-up.

Statistically robust with p-values: Cobb 81° vs 53° (p=0.003); progression ≥5°: 64% vs 30% (p=0.04)

- Limitations:

Small observation cohort (n=11) limits generalizability.

Indications for ROI and patient selection unclear—could bias results.

Lack of data on functional outcomes or complications post re-implantation.

Does not assess long-term outcomes past 2 years or final fusion timing.

5.5

(Moderate quality; clinically relevant, but underpowered and limited in scope)

Prompt re-implantation after growth‑friendly device removal appears crucial to arrest deteriorating curves in EOS. However, decision-making should be individualized, considering technical feasibility and patient comorbidities.

Re-inserting a growth-friendly implant within 12 months of removal significantly reduces coronal curve progression over 2 years and should be prioritized when feasible—though data are limited by small control group and absence of long-term outcomes.

Published online: July 4, 2025 Corresponding author: msm2244@cumc.columbia.edu.