Shilla Growth Guidance Compared With Magnetically Controlled Growing Rods in the Treatment of Neuromuscular and Syndromic Early-onset Scoliosis

Abstract

Study Design. Retrospective review of consecutive series of patients treated at two institutions. Objective. The aim of this study was to compare the health-related quality of life (HRQoL) and surgical outcomes of Shilla growth guidance and magnetically controlled growing rod (MCGR) treatment in patients with syndromic and neuromuscular early-onset scoliosis (EOS). Summary of Background Data. Knowledge of the outcomes of Shilla instrumentation is limited. Methods. We identified 13 children treated with Shilla and 18 children treated with MCGR with syndromic or neuromuscular EOS (major curve ≥45 degree) before the age of 10 years with minimum 2-year follow-up. Outcome parameters included clinical data, radiographic as well as HRQoL outcomes (EOSQ-24 questionnaire). Results. Mean preoperative major curves were 64 degree (range, 45–108 degree) in the Shilla group and 58 degree (range, 45–85 degree) in the MCGR group (P = 0.151). At final follow-up, mean major curves were 31 degree (range, 9.4–54 degree ) and 30 degree (range, 16–53 degree), respectively (P = 0.392). The mean major curve correction was 45% in the Shilla group and 48% in the MCGR group during the follow-up (P = 0.383). Spinal (T1-S1) and T1-T12 growth were significantly better (P = 0.006 and 0.042) in the MCGR than in the Shilla group during the distraction period. At final follow-up, 11 (85%) children in the Shilla group and 17 (94%) in the MCGR group had achieved T1-T12 length of ≥18 cm (P = 0.202). There were significantly more surgical procedures in the MCGR group (mean 2.6 vs. 1.4, P = 0.034) with no difference in the number of complications (P = 0.768). EOSQ24 domains were similar at final follow-up. Conclusion. Shilla growth guidance provided similar correction of spinal deformity, equal number of complications, but with significantly less surgical procedures in patients treated for EOS when compared with MCGR instrumentation. MCGR provided with slightly better spinal growth during the distraction period. There were no significant differences between the quality of life assessments. Level of Evidence: 3

Complications in growth-friendly spinal surgeries for early-onset scoliosis: Literature review

“…As in the main texts, the data were not separated out, so we included them in the TGR group, as the vast majority were treated with this system. Papers by Akbarnia et al [ 10 ], Bachabi et al [ 11 ], Haapala et al [ 12 ], Andras et al [ 13 ], and Luhmann et al [ 14 ], dealt with comparisons between TGR and MCGR, TGR, and VEPTR, Shilla and MCGR, and TGR and Shilla, respectively, so they appear in the table for the applicable system. The demographic findings of the included articles are summarized in Table 1 .…”

“…The complication rate was as high as 111% of the patients (39%-192%), and the complication rate per surgical procedure was 54%. Haapala et al [ 12 ] showed the fewest complications – 39%. The remaining authors assessed the number of complications at a similar level.…”

Does Implant-Related Complications Interfere with Correction in the Shilla Technique Performed to Treat Early Onset Scoliosis?

“…Early-onset scoliosis (EOS) is a progressive disorder that includes complex curvatures of the pediatric spine related to different etiologies (idiopathic, congenital, syndromic, and neuromuscular) in children younger than 10 years. If left untreated, EOS in these patients may lead to poor respiratory and cardiac development and progressive deformities and cause complex and difficult-to-treat spinal problems [1][2][3]. Currently, surgical treatments with growth-preserving instrumentation (GPI) techniques without growth arrest are preferred in cases of high-angle and progressive EOS.…”

“…The purpose of EOS surgery is to avoid postoperative complications when selecting the appropriate GPI for the patient. Many multicenter studies have compared the advantages and disadvantages of different growth-friendly techniques [1,[13][14][15].Similar to other techniques, various problems may occur as a result of Shilla application. The Shilla technique aims to avoid these problems and the problems caused by active lengthening procedures.…”

Cost-Utility Analysis of Anterior Vertebral Body Tethering versus Spinal Fusion in Idiopathic Scoliosis from a US Integrated Healthcare Delivery System Perspective

“…However, the use of these technologies in recent studies has been limited to younger patient populations, [17][18][19][20][21][22][23][24][25][26][27][28][29][30][31] with current indications in the US limited to patients with early-onset scoliosis (<10 years of age), 32,33 and while these technologies allow fusion to be delayed until skeletal maturity is reached, a final fusion procedure is still required.…”