A prospective, multicenter cohort study recently published in Spine Deformity has demonstrated that the Modern Luque Trolley (MLT) technique significantly reduces reoperation rates in children with early-onset scoliosis (EOS) and is associated with a low implant failure rate, compared to traditional growth-friendly surgical methods.

Study Overview 

Led by Jean Ouellet and an international team of spine specialists, the study enrolled 18 EOS patients treated with MLT, a growth guidance construct, and compared them to 43 matched historical controls drawn from the PSSG (Pediatric Spine Study Group) who underwent treatment with dual growing rods (DGR), rib-based growing rods (RBGR), or magnetically controlled growing rods (MCGR). The primary endpoint was the number of spinal reoperations within three years post-surgery.

Key Findings

1. Only 1 of 18 MLT patients (5.6%) required reoperation within 3 years of surgery, compared to 30 of 43 controls (69.8%). Conditional Poisson regression yielded a rate ratio of 0.02 (95% CI: 0–0.12, p < 0.001)
2. The median time to first reoperation was 5.4 years for MLT vs. 4.3 years for MCGR and 0.5 years for DGR AND RBGR.
3. Total spinal growth (T1–S1) was comparable between groups, although thoracic growth (T1–T12) was slightly lower in the MLT group.
4. The MLT group achieved the same curve correction as the controls at 3 years. Initial curve correction was greater in MLT patients, but they experienced more postoperative loss of curve correction.
5. No difference was observed in standing heights and quality of life (EOSQ-24) scores.
6. MLT patients had no spontaneous spinal fusion and only one patient experienced implant loosening. Adverse events were fewer and less severe than in control groups.

Clinical Implications

The MLT technique, which captures the apex of the deformity with gliding anchors via a minimally invasive approach, markedly reduces the need for repeated surgeries in children with EOS. It addresses key limitations of earlier Luque trolley designs and modern growing rod systems, particularly the high rates of implant failure and spontaneous spinal fusion seen in other growth sparing techniques.

Limitations

A historical cohort was used as the study’s control group control, and some matching criteria (e.g. curve flexibility) were unavailable. The follow-up period was limited to three years, and sample size constraints affected statistical power for secondary outcomes like quality of life.

Conclusion

The MLT technique is a promising solution for EOS management, with markedly lower reoperation rates, comparable spinal growth, and favorable safety outcomes. Longer-term studies are needed to confirm sustained benefits and refine patient selection criteria.