Richard E McCarthy1, Frances L McCullough1. 1. Arkansas Children's Hospital, University of Arkansas for Medical Sciences, 1 Children's Way, Slot 839, Little Rock, AR 72202. E-mail address for R.E. McCarthy: rmccarthy@uams.edu. E-mail address for F.L. McCullough: mcculloughfl@archildrens.org.
Abstract
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.
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.
Authors: Pooria Hosseini; Allen Carl; Michael Grevitt; Colin Nnadi; Martin Repko; Dennis G Crandall; Ufuk Aydinli; Ľuboš Rehák; Martin Zabka; Steven Seme; Behrooz A Akbarnia Journal: Int J Spine Surg Date: 2018-08-31
Authors: Nicholas Vaudreuil; Jingbo Xue; Rahul Ramanathan; Robert Tisherman; Malcolm Dombrowski; Wen-Jun Wang; Kevin Bell Journal: JOR Spine Date: 2018-10-08