Radiographic Outcomes of Shilla Growth Guidance System and Traditional Growing Rods Through Definitive Treatment.

STUDY DESIGN: Retrospective review of a multicenter database. OBJECTIVES: To compare the radiographic outcomes of patients who had undergone the Shilla Growth Guidance System (SGGS) and traditional growing rod (GR) treatment for management of early-onset scoliosis (EOS) through definitive treatment. SUMMARY OF BACKGROUND DATA: The efficacy of surgical treatment of EOS can only be determined after definitive treatment has been completed. We wanted to review our experience with the SGGS and GR for management of EOS through definitive treatment. METHODS: Patients who had surgical treatment with SGGS or GR and had undergone definitive treatment were included. The patients were matched by age, preoperative curve magnitude, and diagnosis. The study population consisted of 36 patients (18 in each group) whose mean age at initial surgery was as follows: SGGS, 7.9 years; and GR, 7.7 years (not significant [NS]). Length of follow-up after initial surgery was 6.1 years for SGGS and 7.4 years for GR (NS). Definitive treatment was posterior spinal fusion (15 SGGS, 17 GR), implant removal (3 SGGS), or completion of lengthenings (1 GR). RESULTS: The preoperative curve was 61 degrees for SGGS and 65 degrees for GR (NS). After index surgery, the major curve decreased to 24 degrees (-37 degrees) for SGGS and 38 (-27 degrees) for GR (p < .05). At last follow-up, the major curve was 34 degrees (44%) for SGGS and 36 degrees (45%) for GR (NS). The initial T1-T12 length for SGGS was 188 mm and for GR, 181 mm; at last follow-up, SGGS was 234 mm (46 mm increase) and GR was 233 mm (52 mm increase) (NS). CONCLUSION: Our analysis shows the final radiographic outcomes (and changes) and complications (implant-related and infection) between the SGGS and GR groups were not statistically different. The main difference between the two groups was the threefold difference in overall surgeries.

Shilla Growth Guidance for Early-Onset Scoliosis: Results After a Minimum of Five Years of Follow-up.

BACKGROUND: The Shilla growth guidance technique was developed to allow growth during treatment of a child's spinal deformity without requiring repeated surgery for lengthening procedures. Dual stainless-steel rods are fixed posteriorly to the corrected apex via pedicle screws with a limited fusion at the apex and are combined with sliding pedicle screws to allow vertebral growth in a cephalad and caudad direction. METHODS: A retrospective study of the original forty patients treated with the Shilla method for a severe deformity of a growing spine was performed to determine the efficacy of the procedure. RESULTS: The etiology of the spinal deformity in the forty patients was idiopathic in nine, congenital in one, neuromuscular in sixteen, and syndromic in fourteen. The average age at the index surgery was six years and eleven months, and the average duration of follow-up for the thirty-three eligible patients was seven years (range, four years and nine months to ten years and nine months). The curves averaged 69° (range, 40° to 115°) preoperatively and 38.4° (range, 16° to 74°) at the time of the most recent follow-up or prior to definitive spinal instrumentation and fusion. Complications included secondary infections (six patients), alignment issues (eight patients), and implant-related problems (twenty-four patients), with some patients experiencing more than one complication. CONCLUSIONS: The Shilla growth guidance technique is a method of scoliosis treatment that allows spinal growth while controlling the deformity without scheduled repeated surgical procedures. The complication rate is high (73%) but acceptable, and children with a wide variety of diagnoses can be safely treated with the Shilla procedure.

The Shilla growth guidance technique for early-onset spinal deformities at 2-year follow-up: a preliminary report.

BACKGROUND: The Shilla growth guidance technique has been developed to treat spinal deformities without the necessity of repeated operative lengthenings. The dual stainless steel rods are fixed to the corrected apex of the curve by pedicle screws with limited fusion about the apex. Vertebral growth occurs in a cephalad and caudad direction through extraperiosteally placed sliding pedicle screws. A retrospective review of patients treated with the Shilla growth guidance technique for early-onset spinal deformity was performed to study patients with >2-year follow-up and describe outcome parameters. METHODS: From a cohort of 38 patients, 10 patients with a mean age of 7 + 6 years were identified as qualifying for 2-year follow-up inclusion. RESULTS: The average preoperative curve of 70.5 degrees was corrected to 27 degrees at 6 weeks follow-up and maintained at 2-year follow-up. The space available for lung improved an average of 13%. Truncal height (C7 to S1) increased an average of 12%. One patient required rod revision, 1 required rod change to a smaller size rod, and 1 required rod replacement. Two patients required wound debridement for low-grade infection in the early-postoperative period for a total of 5 procedures beyond the index correction. No patient had changes neurologically as a result of surgery. Patients were braced for the first 3 months postoperatively while the fusion was incorporating then not thereafter. CONCLUSIONS: At 2-year follow-up, the Shilla procedure has allowed children correction of their spinal deformity with an acceptable complication rate and ability to grow brace free without repeated trips to the operating room for lengthenings. These patients would have had 49 scheduled lengthening procedures after their initial correction if treated by conventional distraction growing rod methods. LEVEL OF EVIDENCE: IV case series of therapeutic study investigating results of treatment.