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Thread: Dr. Douglas Kiester discusses MAGEC - Remote Control Spinal Deformity System

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    Dr. Douglas Kiester discusses MAGEC - Remote Control Spinal Deformity System

    Dr. Douglas Kiester is an Orthopaedic Surgeon with an expertise in spinal reconstruction. He is a Professor in the Department Of Orthopaedic Surgery at the University of Irvine. Dr. Kiester is the inventor and patent holder on numerous medical devices. His latest invention is the MAGEC - Remote Control Spinal Deformity System. The MAGEC system recently won the 2011 Best New Technology In Spine Care Award. The first application for this device is the treatment of childhood Scoliosis. Click to see a video of the device. Here is an article in the UK Daily Mail about the device. (Now I can walk tall... all thanks to my remote controlled bionic spine)

    Question) How does the MAGEC system treat idiopathic Scoliosis?

    Dr. Kiester) For over 25 years I have been very certain that Adolescent Idiopathic Scoliosis (AIS) is mechanically caused by ligaments in the back of the spine that are too tight to accommodate growth. I patented the concept of treating AIS with a device that slowly stretches out the spine over time. The motor conceived in the patent was a wire that turned a ratchet when heated with a tightly directed radio wave. The head of Ellipse Technologies e-mailed me to say that they had a motor that would make my device work. Their office was located between my home and my office.

    What Ellipse had was a small cylinder magnet that would rotate when another magnets was rotated near it. This would work while they were several inches apart. The device we created is a rod that can be implanted by the spine that lengthens when these magnets are activated close by on the skin. The activation mechanism is computer controlled so that the rod lengthens exactly the desired amount on each activation. Verification of the new rod length is easy to do with an x-ray.

    The rod is anchored to the spine on both ends with screws. When it is activated it is like when a child goes to the dentist to get the braces on their teeth adjusted. The lengthened rod slowly stretches out the spine just like the braces slowly pull the teeth into a straight alignment.

    Question) Why is your device superior to traction or stretching exercises?

    Dr. Kiester) Traction can't pull hard enough to stretch out the ligaments involved. Your skin is too soft, making the traction too weak to be effective. Also while braces on the teeth pull 24/7, traction can only be applied for a limited time each day.

    Exercises have been tried for literally hundreds of years without much success. Part of that failure is because people believe that the problem with scoliosis is the spine bending to the side. And so they have concentrated on doing ineffective exercises. The bending to the side is not the primary problem. That is a side effect (no pun intended). The primary problem is the ligaments in the back of the spine that need to be stretched. Again, these ligaments are too tight for flexion exercises to help much. The one exception may be Dr. Vert Mooney's trunk rotation exercises which seem to have the unexpected consequence of stretching the right ligaments, and therefore seem to be somewhat effective. Again, exercising for hours at a time is no match for the braces on your teeth that are constantly pulling.

    So why don't scoliosis braces work better? No one really notices, but while the brace is being fit, the orthotist pushes the side bend toward the midline. This causes the patient to stand up straighter, and even extend their back. The brace then locks them in this position. The x-ray in the brace looks better, because the curve is less, but no one notices that the spine is now braced in extension. To stretch the culprit ligaments requires flexion which is just the opposite of extension. Now firmly braced, the spine doesn't get to bend and stretch with day to day activities. Just as soon as the brace comes off and the patient bends forward the curve goes back to where it was (or worse).

    Question) Does MAGEC treat the lateral curve, rotation or both?

    Dr. Kiester) What MAGEC does is stretch the ligaments at the back of the spine. It has only been in the past few years that Dr. Lenke has published that the scoliotic spine is almost always in extension. Prior to his publication, people did not understand this. As the spine is stretched, the normal forward bending is slowly restored. Now there is enough space in the front of the spine for the front of the vertebra to return toward the midline. As the spine is stretched further, the spine becomes straight. The rotation is because the back of the spine is held on the midline where the tight ligaments are, while the vertebra leave the midline to find room to grow. If the back stays in the middle while the front leaves the middle, the result is rotation. As the front is gently pulled back toward the midline, the rotation, by definition, goes away along with the curve.

    Question) What does surgical implantation of your device entail? Are there restrictions after surgery?

    Dr. Kiester) To anchor the MAGEC rod, pedicle screws are placed at both ends, two screws on each end for a total of 4 screws per rod. Many of the doctors who are testing this system overseas are putting two rods; one on the right, and one one the left. The normal fusion rod has many points where it is attached to the spine. The MAGEC rods are attached only on the ends. This makes them less stable than a fusion rod, so activities need to limited, and sometimes soft braces to slow down the body movements are used.

    Question) How many implants will a patient receive? Where in the spine does the surgeon place the system?

    Dr. Kiester) The rods are placed with one end at the start of the curve and the other end at the end of the curve.

    Question) Once the device is implanted how often will it be adjusted by a physician? What happens during an adjustment?

    Dr. Kiester) Our studies showed that the rod could be safely lengthened every week. For further safety the rods are currently being lengthened every 2 to 6 weeks. The child comes to the doctor's office. There is no sedation or pain medication given. The child lays face down, and the lengthening device is activated for one to two minutes. The children are not reporting anything more than mild discomfort when the rod(s) are lengthened.

    Question) Is the system removed or turned off when the patient reaches skeletal maturity?

    Dr. Kiester) There is nothing in the rod to turn off. The "motor" is a magnet. That's it. A simple magnet which rotates on a threaded screw. The plan is to remove the rods once the stretching is done. This involves one small incision on each end of the rod so that the anchors can be removed. The rod is then pulled out though one of those small incisions. Anytime there is metal around bone that is moving, the metal will eventually loosen, and/or break. There is no fusion with this rod. The spine is fully mobile at the end of treatment. The spine does not get stiff or fuse. Thus the rod needs to be removed.

    Question) Is the MAGEC system designed for a specific type of spinal curve or can it be used to treat the broad, patient population?

    Dr. Kiester) The MAGEC was designed with AIS in mind, but it has been warmly welcomed by the families and doctors treating congenital scoliosis. This is a very different condition that becomes manifest very early in a child's life. Before MAGEC "growing" rods required open surgery for each lengthening to keep up with the child's growth. As such lengthenings occur typically only every 6 months or so. Because the lengthenings are far apart, the doctors do their best to overstretch the device as much as possible with each stretching. This is very painful, and often requires several days in the hospital for pain control after a lengthening surgery. Many of the earliest patients to use the MAGEC were congenital scoliosis patients. The reviews from these doctors and patients have been very positive.

    Because adult scoliosis works by yet another completely different mechanism which is now just beginning to be well understood by the more advanced spine surgeons, the MAGEC really doesn't have any place in the treatment of adult scoliosis. This technology won't work in that setting.
    Last edited by Dingo; 12-04-2011 at 10:09 PM.

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    part 2

    Question) Is this device designed for children in a specific age range? Can it be used for infantile or juvenile patients?

    Dr. Kiester) The designation "juvenile scoliosis" has almost disappeared. It is really just a young version of AIS. The MAGEC works well here. Once the spine has finished growing, or begins to get stiff or lose flexibility, the MAGEC ceases to be able to work its magic.

    Question) A study recently published in the European Spine Journal (A biomechanical study on the effects of rib head release on thoracic spinal motion) found that when surgeons cut ligaments in a Scoliotic spine it released pressure which caused the rib cage to immediately derotate. Does evidence like this suggest that your device might help children even after they’ve reached skeletal maturity?

    Dr. Kiester) The study you've pointed out says that better corrections may be easier if the ligaments around the ribs are released first. While this is interesting, the ligaments they are releasing won't make much difference for scoliosis surgery as it is currently done. The biggest limit to correction right now is damage to the spinal cord from stretching it too much during surgery. The current spine fixation technologies are able to do significant spine correction but correction involves stretching the spine. If during these corrections the spinal cord monitoring says there is a problem, then the surgeon must release the pressure, unstretch the spine, and accept less correction than desired for that spine. Releasing ligaments around the ribs simply will not change much how we now do spine surgery. By slowing stretching the spine over time, the spine lengthens quite well without damage or difficulties, and better corrections are thus possible.

    As to doing these kinds of releases in young adults and then using the MAGEC, scoliosis spines become stiff when they are finished growing. I have even noticed that some of the ligaments start to turn into bone as the spine stiffens. This stiffness is a defensive mechanism that prevents the curve from getting worse (it's as if the patient does their own fusion). Once a spine has reached that point, the MAGEC will probably not work well.

    Question) How is MAGEC being tested? Do you have plans to expand the testing of your device? Do you have a time frame for when your system might become available to patients in The United States?

    Dr. Kiester) Because of FDA requirements the MAGEC is currently going through human trials overseas. Prior to those tests, the device went through the full battery of biomechanical testing (and other tests) required by the FDA for rod based spine stabilization devices. It is hoped that the data from these trials and the testing will open the door for trials in the United States. I do not know when it will become available here.

    Question) Currently MAGEC is being used to treat Scoliosis. What other health problems might it be used for in the future?

    Dr. Kiester) You ask a question I've been asked many times. Right now were are looking into other applications which I can't disclose just yet.

    Question) You’ve worked on the front lines of biomedical engineering for many years. Do you have any words of wisdom to engineers who want to develop their own products?

    Dr. Kiester) My advice to engineers is do what you love. And don't expect to get rich. Of the many patents I've been awarded, only a few have made it to the market, at least under my name. It is like anything in life, if you are doing what you love, you will find success. I have fought with NASA over data which they have which proves Hubble was wrong, and there was never a Big Bang. And I have shown the world the gross engineering error the current lumbar disk replacement designs are which helped remove them from the market before they could injure more people. And I'm doing some archeological research right now that is really beyond belief. None of these things have made me either rich or famous, but I've had a good time. My goal of life-long learning and steadily increasing skills has been a roaring success. And I've had fun. If your project doesn't awaken you in the middle of the night, or dominate your thoughts in the morning shower, it's not the project for you. Move on.
    Last edited by Dingo; 12-02-2011 at 10:04 AM.

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    Quote Originally Posted by Dingo View Post
    I have fought with NASA over data which they have which proves Hubble was wrong, and there was never a Big Bang.
    Heh. Absolutely lovin' this. A surgeon fighting with NASA over the fact of the Big Bang. Love it!

    And I'm doing some archeological research right now that is really beyond belief.
    Oh I bet it's biblical archaeology or maybe ancient space aliens! HA!
    Last edited by Pooka1; 12-02-2011 at 03:23 PM.
    Sharon, mother of identical twin girls with scoliosis

    No island of sanity.

    Question: What do you call alternative medicine that works?
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    "We are all African."

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    followup answer

    I asked Dr. Kiester a little more about torso rotation and I felt the exchange was illuminating so I'll add it here.

    Question) Your answer on the ineffectiveness of traction and exercise got me thinking.

    "Again, exercising for hours at a time is no match for the braces on your teeth that are constantly pulling."

    You are absolutely correct. When my son does torso rotation exercises he performs 3 sets of 15 on each side. The total time he spends exercising is literally a couple of minutes. I don't see how that small amount of stretching could make much difference. Could torso rotation work because of some sort of secondary action? For instance maybe this type of exercise releases hormones that stretch the ligaments in the spine? Maybe some other secondary effect? But you're right, a few minutes of exercise probably isn't enough to have a direct impact on the ligaments.

    Dr. Kiester) Reasonably directed exercise is of huge impact which is why the immobilization of body bracing has such negative effects. The amount the ligaments have to stretch to stop the progression of the curve is surprisingly small. Thus a little exercise of an effective kind may even result in some reversal of the deformity. Doing a moderate force of continuous stretching (like putting braces on teeth) is when the goal is complete or near complete restitution of the normal anatomy.
    Last edited by Dingo; 12-02-2011 at 03:20 PM.

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    Dingo does it again! :-)

    Kudos to you. Dr. Kiester is exceptionally nice to have responded to you....twice! And so many interesting comments of his. Wow.

    The biggest drawback I see to his device is that kids need to restrict activities, possibly wearing a brace. I don't think my daughter would have dropped ballet in order to have that implant...but maybe they don't mean that much restriction. Interesting, but a drawback nevertheless. It sounds like it's too late for my daughter anyway. I thought he had said earlier that it could be used for adults also...but perhaps he has something else he's cooking up for them. Stay tuned I guess.

    Really interesting comments of his concerning juvenile scoliosis = AIS, ligaments turning to bone at maturity, advice to engineers, why he thinks bracing makes things worse...of course, if there's no alternative to progressing and having fusion I'll take the brace even with it's problems.

    Please thank him for all of us here, his information is very interesting, informative and appreciated. I may eventually have take my daughter in to see him just to hear what he has to say about her and any potential treatments that may become available in the future.

    Thank again Dingo. You are a big asset to this site!

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    Quote Originally Posted by Dingo View Post

    Dr. Kiester) Reasonably directed exercise is of huge impact which is why the immobilization of body bracing has such negative effects. The amount the ligaments have to stretch to stop the progression of the curve is surprisingly small. Thus a little exercise of an effective kind may even result in some reversal of the deformity. Doing a moderate force of continuous stretching (like putting braces on teeth) is when the goal is complete or near complete restitution of the normal anatomy.
    I wonder if this is why my daughter was successful at bracing. She has spent at least two hours a day plus many more hours for years during her growth spurt. It may have been enough in combination with her nighttime brace to stretch the ligament enough for her not to progress. And she avoided the problems with wearing an all day brace.

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    Thanks Ballet Mom!

    I wouldn't have known to write him if it wasn't for you.

    Dr. Kiester is a first rate human being. We are very lucky he chose to work in the field of Scoliosis.

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    Quote Originally Posted by Dingo View Post
    Thanks Ballet Mom!
    Dr. Kiester is a first rate human being. We are very lucky he chose to work in the field of Scoliosis.
    Yesss!!! Long life to Dr. Kiester! I hope he remains interested in scoliosis. It seems he use a logic reasoning and common sense!!!.. and takes in mind Problem Solving concepts, so he was not blocked thinking only in the first cause (why the ligament turned tight?..)
    It’s extremely obvious that some back component should to be the CURRENT cause that provoke a stiff spine. Is difficult to imagine that the guilty may be vertebras (at least without a great deformation) or discs or organs, so only may be the rib cage, fascias, joints, tendons or (more obvious at least for lay people) muscles or ligaments.

    Thanks Dingo and Ballet Moon!!
    Last edited by flerc; 12-05-2011 at 05:08 PM.

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    Quote Originally Posted by Dingo View Post
    [B]
    I have even noticed that some of the ligaments start to turn into bone as the spine stiffens.
    Always happen that? Only with scoliosis or also without it?

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    Quote Originally Posted by Dingo View Post
    The primary problem is the ligaments in the back of the spine that need to be stretched. Again, these ligaments are too tight for flexion exercises to help much. The one exception may be Dr. Vert Mooney's trunk rotation exercises which seem to have the unexpected consequence of stretching the right ligaments, and therefore seem to be somewhat effective.
    Why that exercise is effective (in stretching right ligaments) and not others? There are not enough knowledge to answer this question?

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    Other surgeons believe that is a fact? http://www.businesswire.com/news/hom...al-deformities
    Why not are all of them talking about this?

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    I am curious about this "tight ligament" theory and how it relates to those of us scoli's who have a connective tissue disorder that results in ligament laxity and hyper mobile joints. It seems like this condition is the total opposite of the tight ligament theory. I have ligament laxity throughout my body, and when I had my surgery last year my surgeon told my husband I had the most flexible spine he had seen in an adult. This was not a good thing, because overly flexible equals unstable.

    Any comments?
    Gayle, age 50
    Oct 2010 fusion T8-sacrum w/ pelvic fixation
    Feb 2012 lumbar revision for broken rods @ L2-3-4
    Sept 2015 major lumbar A/P revision for broken rods @ L5-S1


    mom of Leah, 15 y/o, Diagnosed '08 with 26* T JIS (age 6)
    2010 VBS Dr Luhmann Shriners St Louis
    2017 curves stable/skeletely mature

    also mom of Torrey, 12 y/o son, 16* T, stable

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    Quote Originally Posted by flerc View Post
    Why not are all of them talking about this?
    The question answers itself.

    Words matter. Kiester did not claim to have evidence for this claim. He said he thinks it is the case. It is his hypothesis. His starting point from which he can move off to investigate the claim. If he did any work to SHOW it rather than just KNOW it, then he would have published it.

    He is not claiming to have shown it so we can't gig him on that. If he claims to KNOW it without SHOWING it then that is faith not science.

    And by the way, the appropriate response from a research astronomer at the Jet Propulsion Lab (NASA) working on Big Bang cosmology to a random surgeon emailing him with comments about astronomy data is to give the surgeon advise about how to do surgery. Obviously.
    Last edited by Pooka1; 12-04-2011 at 11:34 AM.
    Sharon, mother of identical twin girls with scoliosis

    No island of sanity.

    Question: What do you call alternative medicine that works?
    Answer: Medicine


    "We are all African."

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    Isn't it interesting that Kiester appears to be spending time telling the JPL cosmologists how to do their research and spending time designing earth-based experiments to show that the Big Bang never happened INSTEAD of designing earth-based experiments to SHOW that the tight ligament hypothesis is correct?

    Perhaps time spent writing a book about medieval religious mumbo jumbo takes up too much of his time to actually show the tight ligament theory is correct. Who knows.
    Last edited by Pooka1; 12-04-2011 at 12:14 PM.
    Sharon, mother of identical twin girls with scoliosis

    No island of sanity.

    Question: What do you call alternative medicine that works?
    Answer: Medicine


    "We are all African."

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    I mean what do parents of kids with scoliosis want more, a handle on what is causing the curvature and rotation or yet another book on medieval religious mumbo jumbo and edifying the "idiot" researchers at JPL on the lack of a Big Bang?

    I ask the jury...
    Sharon, mother of identical twin girls with scoliosis

    No island of sanity.

    Question: What do you call alternative medicine that works?
    Answer: Medicine


    "We are all African."

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