Now I can walk tall... all thanks to my remote controlled bionic spine



Bionic spine: Natasha Rahman, 11, is one of the first British children to have the procedure

A young girl dressed in a T-shirt and jeans lies on her front on an examination bed. She lets out a nervous giggle as her surgeon hovers a small hand held electronic device over the middle of her back. ‘I can sort of feel something clunking inside,’ she says, hesitantly. Within ten minutes the girl is walking around the room, gingerly at first and then with confidence.



‘It feels a bit tight in my back. Weird . . . but it doesn’t hurt,’ she says, smiling.



The patient is 11-year-old Natasha Rahman, one of the first British children to have a bionic bone implant fitted to her spine. The electronic ‘growing’ rod is the latest development in the treatment of scoliosis, a disfiguring spine problem that affects 45,000 British children.



Natasha, who lives with her parents Aj, 48, chairman of an international logistics firm, and Nathalie, also 48, in Roehampton, South-West London, had the titanium implant inserted during a surgical procedure in June. Now she has undergone the first adjustment, in which the rods are lengthened via remote control, to account for her fast-growing body. Afterwards, she slips on her shoes and is taken back to school by her mother.



Scoliosis – the name comes from the Greek word skoliõsis, which means ‘crooked’ – is a condition that causes the spine to curve, sometimes drastically, to the left or right.

It usually occurs in pre-adolescent children, and in severe cases there can be multiple twists causing a hump. Nine in ten cases resolve naturally as the child grows, but in those who suffer in long-term, if left untreated the deformity can become difficult – if not impossible – to correct.

Implanting rods into the spine to straighten it is the standard procedure now used – one famous sufferer, Princess Eugenie, had the treatment aged 12.



Fortunately for Eugenie, now 21, surgery was a complete success and she is reported to have needed no further intervention. However, the majority of children with severe scoliosis need up to 20 corrective operations as they grow to replace the implants with larger ones, in order to keep the curve in their back in a normal position. Each procedure can cost the NHS up to £20,000.



If not enough adjustments are made, studies show the spine begins to twist – and the strength of the abnormal muscular contractions, thought to be the cause of scoliosis, bends the rods. Some follow-up X-ray studies have shown that in up to one in ten patients who underwent titanium rod implantation in childhood, scoliosis had returned to pre-operative levels.

But the remarkable growing implant, known as the magnetic expansion control system, or simply MAGEC, means young patients will now need to undergo only a single surgical procedure. After that, the telescopic device can be adjusted as regularly as needed without a single incision being made.



So far about 40 patients have been implanted by orthopaedic surgeon Hilali Noordeen at the Royal Orthopaedic Hospital in Stanmore, North London – where Eugenie was treated. The technology isn’t yet available throughout the NHS, but there are plans for large-scale trials in other centres next year.



‘Having scoliosis is bad enough but what these kids have to go through to get their backs straightened at present is quite something,’ says Mr Noordeen, who helped pioneer the use of titanium rods in the mid-Nineties.



Earlier options included traction, in which the spine was physically stretched to attempt (usually unsuccessfully) to straighten it, and bracing, which involved various kinds of supportive corset.

Implantable rods marked the first true advance in treatment of the condition. However, as Mr Noordeen points out: ‘Adjusting the rods is major surgery. And each time you are running the risks of infection and complications. On top of that is the emotional factor of bringing the children in.



‘It disrupts home life for them and their parents and afterwards they have to stay in hospital for a day or two to recover, and it’s weeks before they’re able to go back to normal life. It is incredible that we can now do the whole thing in minutes.’



During the initial procedure, the patient is implanted with one or two MAGEC rods while under general anaesthetic. An incision of just under one inch is used to insert the rods, which slide into place. They are positioned alongside the spine and fixed with screws.



The devices have an internal magnet, allowing them to be adjusted by an external remote control. They also contain a pressure sensor, which tells the handset when the optimum length has been reached, allowing them to be adjusted ‘blind’, without X-rays or other internal scanning.



'We are so happy - now she can grow up like any normal child'

The procedure takes about three hours. The stay in hospital is normally a week, with the child back at school in three to five weeks. Adjustments are carried out by the surgeon in hospital but the hope is that in the future the procedure will be carried out by specially-trained orthopaedic nurses or even a GP.



Natasha first became aware of problems with her back last year. Her mother explains: ‘We didn’t know there was anything wrong but then Natasha fell on her back and we took her to the doctor to be checked out. The GP said there was no bruising, but noticed she wasn’t standing quite right.’



Although it can be caused by conditions such as cerebral palsy and muscular dystrophy, in about eight out of ten cases of scoliosis, the cause is unknown. In about a third, the child has some family history of the condition.



This wasn’t the case for Natasha.The problem is not caused by bad posture, exercise, diet or by carrying backpacks or satchels.



‘X-rays at the hospital confirmed she had scoliosis,’ her mother says. ‘They wanted to start treatment by putting her in a restricting corset, and then give her surgery. She didn’t want the corset at all, and we all decided together that if she was going to need surgery, she might as well have it sooner rather than later.’



Adults who had scoliosis when they were children are more likely to develop chronic (long-term) back pain. Those with scoliosis that is left untreated are also more at risk of developing arthritis in their spine.



Mr Noordeen expects MAGEC to become the norm for scoliosis surgery over the next few years. The implant operation costs about £20,000. ‘It is a wonderful advance that will make the treatment of this debilitating disease so much more bearable,’ he says.



For Natasha, the only legacy of her operation is two scars on her back that will eventually fade to nothing. ‘I like swimming and running. I like gymnastics, too,’ she says.



Her mother is thrilled. ‘We are so happy – now she can grow up like any other healthy child her age.



And I think she secretly likes the idea that she’s a bionic girl. How many people can say that?’



Scoliosis Association UK, www.sauk.org.uk, British Scoliosis Research Foundation, bsrf.co.uk



