Active Apex Correction With Guided Growth Technique for Controlling Spinal Deformity in Growing Children: A Modified SHILLA Technique

Abstract

Study Design: A retrospective study. Objective: To determine if active remodulation in the apex of the curve is possible in scoliosis and kyphoscoliosis patients, using a modified SHILLA; active apex correction (APC) technique for guided growth. Method: Twenty patients with either scoliosis or kyphoscoliosis underwent a modified SHILLA approach, where instead of apical fusion, APC was applied. In this modified technique, the most wedged vertebra was selected followed by insertion of pedicle screws in the convex side of the vertebrae above and below the wedged one. The convex and concave heights of the wedged and control vertebrae were recorded at the time of the surgery and at follow-up duration, both using computed tomography. Results: The wedged vertebra demonstrated in average a 17% (P =.00014) increase in the proportion of concave to convex heights ratio, whereas the control vertebra did not show any relative change in the wedged vertebra heights at the follow-ups. Conclusion: APC, instead of apical fusion in SHILLA remodulates the apex vertebra, which may in turn help mitigate loss of correction on long term due to crankshafting and adding-on.