New developments in the treatment of early-onset spinal deformity: role of the Shilla growth guidance system

Abstract

Early-onset scoliosis is a complex condition with multiple facets. The goal of treating any spinal deformity is to improve the condition of the patient with the least intervention necessary. A system that allows for continuation of natural spinal growth while correcting the deformity should be the goal of treating this complex condition. The SHILLA growth guidance system allows for continued growth of the pediatric spine while correcting and guiding the apex and guiding the future growth of the curvature. The system involves selective fusion across the apex of the curvature, and minimally invasive instrumentation is then used above and below the apex to allow for continued growth of the spine. A review of recent literature on the SHILLA growth guidance system shows promising results. Early animal models showed continued growth across unfused levels with minimal facet articular damage. Comparative studies to traditional growing rods showed significantly less total surgeries along with comparable correction and longitudinal growth. The SHILLA growth guidance system is a good option for this complex patient group. Results are comparable with other growing constructs with significantly less operative interventions. The SHILLA system allows for natural growth of the pediatric spine while correcting the scoliotic deformity in a minimally invasive method. The goal of this article is to present a comprehensive review of the SHILLA system surgical technique and the associated literature concerning this topic.

Comparison of Different Surgical Systems for Treatment of Early-onset Scoliosis in the Context of Release of Titanium Ions

“…Macroscopically visible impurities were also observed in a caprine animal model 17 . Morell and McCarthy and Singh et al also reported tissue inflammation with characteristics of metallosis 16,18 . In the present study, we did not observe periimplantitis, and the metallic particles were much smaller (<25 μm), which may be related to the fact that the tested systems are based on a titanium alloy rather than a steel alloy.…”

“…This observation is in agreement with literature reports. Morell and McCarthy 16 observed local metallosis in patients with the steel Shilla system and the metallic debris was up to 45 μm in diameter. Macroscopically visible impurities were also observed in a caprine animal model 17 .…”

Biomechanical Analysis of a Growing Rod with Sliding Pedicle Screw System for Early-Onset Scoliosis

“…The GRSPSS system represented a similar mechanical construct to the FDA-approved SHILLA device. While there has been good clinical follow-up reported for the SHILLA system at two and five years [21, 26], to date, there is little to no in vitro biomechanical evidence characterizing the stability of either the GRSPSS or the SHILLA systems. This is particularly concerning given that rod breakage has been reported as a frequent complication associated with the SHILLA system, occurring in up to 30% of patients, and may be in association with increased motion at the fused apical segment [27–29].…”

Understanding the implant performance of magnetically controlled growing spine rods: a review article

“…Examples of guided growth systems are Shilla growth guidance system (SGSS) and modern Luque trolley (MLT). SGGS is a new technique based on the use of pedicle screw fixation and dual rods, able to slide in order to follow the spine growth [18,19] . Few studies are available on this technique, showing similar complication rates when compared to TGR [20,21] .…”