The Shilla Growth Guidance Technique for Early-Onset Spinal Deformities at 2-Year Follow-Up

McCarthy, R.; Luhmann, Scott J.; Lenke, Lawrence G.; McCullough, Frances L

doi:10.1097/bpo.0b013e31829f92dc

Cited by 116 publications

(87 citation statements)

References 33 publications

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“…Locking only proximal and distal anchors helped to maintain correction, and keeping all other set screws at the apical and intermediate region loose allowed vertical growth. The Shilla growth guidance technique, designed by McCarthy et al [18], to eliminate the necessity of repeated lengthenings had a similar construct as our modified technique. The Shilla system had an apical foundation with short segment posterior fixation and fusion with loose proximal and distal anchors to control deformity.…”

Section: Discussionmentioning

confidence: 99%

“…However, in general, growing rods are lengthened every 6 to 8 months, which can be problematic in children with comorbidities. Recently, McCarthy et al [18] developed the Shilla growth guidance technique to treat early-onset spinal deformities without the necessity of repeated lengthening, which included short segment posterior fixation and fusion at the apex of the deformity. However, long-term effects of apical short segment fixation and fusion can be unpredictable.…”

Section: Introductionmentioning

confidence: 99%

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Apical and Intermediate Anchors Without Fusion Improve Cobb Angle and Thoracic Kyphosis in Early-onset Scoliosis

Enercan¹,

Kahraman²,

Ertürer³

et al. 2014

Clin Orthop Relat Res

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Background The main goal of treatment in early-onset scoliosis is to obtain and maintain curve correction while simultaneously preserving spinal, trunk, and lung growth. This study introduces a new surgical strategy, called the modified growing rod technique, which allows spinal growth and lung development while controlling the main deformity with apical and intermediate anchors without fusion. The use of intraoperative traction at the initial procedure enables spontaneous correction of the deformity and decreases the need for forceful correction maneuvers on the immature spine and prevents possible implant failures. This study seeks to evaluate (1) curve correction; (2) spinal length; (3) number of procedures performed; and (4) complications with the new approach. Description of Technique In the initial procedure, polyaxial pedicle screws were placed with a muscle-sparing technique. Rods were placed in situ after achieving correction with intraoperative skull-femoral traction. The most proximal and most distal screws were fixed and the rest of the screws were left with nonlocked set screws to allow vertical growth. The lengthening reoperations were performed every 6 months. Methods Between 2007 and 2011, we treated 19 patients surgically for early-onset scoliosis. Of those, 16 (29%) were treated with the modified growing rod technique by the senior author (AH); an additional three patients were treated using another technique that was being studied at the time by one of the coauthors (CO); those three were not included in this study. The 16 children included nine girls and seven boys (median, 5.5 years of age; range, 4-9 years), and all had progressive scoliosis (median, 64°; range, 38°-92°). All were available for followup at a minimum of 2 years (median, 4.5 years; range, 2-6 years). Results The initial curve Cobb angle of 64°(range, 38°-92°) improved to 21°(range, 4°-36°) and was maintained at 22°(range, 4°-36°) throughout followup. Preoperative thoracic kyphosis of 22°(range, 18°-46°) was maintained at 23°(range, 20°-39°) throughout followup without showing any substantial change. There was a 47 mm (range, 38-72 mm) increase in T1-S1 height throughout followup. The mean number of lengthening operations was 5.5 (range, 4-10). The mean T1-S1 length gain from the first lengthening was 1.18 cm (range, 1.03-2.24 cm) and decreased to 0.46 cm (range, 0,33-1.1 cm) after the fifth lengthening procedure (p = 0.009). The overall complication rate was 25% (four of 16 patients) and the procedural complication rate was 7% (seven of 102 procedures). We did not experience any rod breakages or other complications apart from two superficial wound infections managed without surgery during the treatment period. The only implant-related complications were loosening of two pedicle screws at the uppermost foundation in one patient.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Apical and Intermediate Anchors Without Fusion Improve Cobb Angle and Thoracic Kyphosis in Early-onset Scoliosis

Enercan¹,

Kahraman²,

Ertürer³

et al. 2014

Clin Orthop Relat Res

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“…spinal growth force to lengthen the assembly; these techniques (Luque Trolley [4], Shilla [5]), using a sliding assembly, are known as growth guidance.…”

Section: Introductionmentioning

confidence: 99%

Fusionless surgery in early-onset scoliosis

Odent

Ilharreborde

Miladi

et al. 2015

Orthopaedics & Traumatology: Surgery & Research

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These techniques are effective in controlling early scoliotic deformity, and to some extent restore spinal growth. However, they show a high rate of complications: infection, rod breakage, spinal fixation pull out and, above all, progressive spinal stiffness, reducing long-term efficacy. Respiratory gain is harder to assess, as thoracic expansion does not systematically improve respiratory function, particularly due to impaired compliance of the thoracic cage.

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“…Though occasional skin ulcers arise, growth occurs while spine flexibility is maintained. published results [7] seem promising, but concerns about early spontaneous fusions and the challenges of placing secure pedicle screws in a young child have limited the procedure's acceptance. A similar growth strategy, the Luque trolley, has been largely abandoned because of early spontaneous fusions complicating growth [6].…”

mentioning

confidence: 99%

CORR Insights®: Apical and Intermediate Anchors Without Fusion Improve Cobb Angle and Thoracic Kyphosis in Early-onset Scoliosis

Stasikelis

2014

Clin Orthop Relat Res

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The Shilla Growth Guidance Technique for Early-Onset Spinal Deformities at 2-Year Follow-Up

Abstract: IV case series of therapeutic study investigating results of treatment.

Cited by 116 publications

References 33 publications

Apical and Intermediate Anchors Without Fusion Improve Cobb Angle and Thoracic Kyphosis in Early-onset Scoliosis

Apical and Intermediate Anchors Without Fusion Improve Cobb Angle and Thoracic Kyphosis in Early-onset Scoliosis

Fusionless surgery in early-onset scoliosis

CORR Insights®: Apical and Intermediate Anchors Without Fusion Improve Cobb Angle and Thoracic Kyphosis in Early-onset Scoliosis

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