Active Apex Correction (Modified SHILLA Technique) Versus Distraction-Based Growth Rod Fixation: What Do the Correction Parameters Say?

INTRODUCTION

SHILLA and growth rods are two main surgical correction techniques for patients with early-onset scoliosis. There have been some comparative studies between the two techniques, where a comparison was made between deformity identifying characteristics such as Cobb angle, apical vertebral translation, coronal balance, spinal length gain, etc. However, the SHILLA procedure experiences loss of correction or the reappearance of deformity through crankshafting or adding-on (e.g., distal migration). The current study identifies a solution with a modified approach to SHILLA (which could help in dynamically remodulating the apex of the deformity and mitigating loss of correction) and presents comparative correction data against the long-established traditional growth rod system.

METHODS

The active apex correction (APC) group consisted of 20 patients and the growth rod group consisted of 26 patients, both with the same inclusion and exclusion criteria. The APC surgical procedure involved a modified SHILLA technique, that is, insertion of pedicle screws in the convex side of the vertebrae above and below the wedged one for compression and absence of apical fusion.

RESULTS

There were no statistical differences between the various spinal parameters (namely, Cobb angle, apical vertebral translation, sagittal balance, and spinal length gain) of the two groups. However, significant differences existed for coronal balance, which in part may have been due to differences in its pre-op value between the two groups.

CONCLUSIONS

APC and the traditional growth rod system showed similar deformity correction parameters at current follow-ups; however, the latter requires multiple surgeries to regularly distract the spine.