Pediatric Spine Foundation

Title: Growth guidance constructs with apical fusion and sliding pedicle screws (SHILLA) results in approximately 1/3rd of normal T1–S1 growth

Authors: Alexander Nazareth, David L. Skaggs, Kenneth D. Illingworth, Stefan Parent, Suken A. Shah, James O. Sanders, Lindsay M. Andras, Growing Spine Study Group

Journal: Spine Deformity

Date: February 24, 2020

Excerpt: Guided growth with apical fusion and sliding pedicle screws (GGC/SHILLA) is an alternative to distraction-based growing rods for the treatment of EOS. This study is the largest case series of patients with EOS treated with GGC outside of the inventor’s institution.

Keywords: Spine growth, Shilla, early onset scoliosis

Summary:

Purpose

This study aims to investigate clinical outcomes in T1–S1 growth in patients with SHILLA instrumentation independent of the inventor's reports. 20 patients with the following diagnoses were included in the study: syndromic (9), neuromuscular (5), idiopathic (3) and congenital (3).

Results

  • Preoperative mean curve was 77° and improved after index surgery to a mean of 29° for a mean change of 48°.
  • Mean increase in spine length after intervention was 51.5 mm and change from postoperative to final follow up was 21.8 mm (4.2 mm/year) which was 36% of predicted growth.
  • 15/20 (75%) patients underwent 21 reoperations most commonly for implant complications and 8/20 (40%) underwent final fusion at a mean of 5.1 ± 1.2 years after GGC.

Discussion Points

  • This study is the largest independent study of patients with EOS treated with GGC outside of the inventor's institution.
  • The change in spine length observed through the follow-up period in EOS patients treated with GGC was approximately 1/3rd of predicted normal growth, and less than 1/3rd of growth reported in previous reports.
  • Similar curve correction and complication rates but less spine growth during the growth period were found compared to prior GGC studies.