The team from the University of Toledo, Ohio—led by legendary Orthopedic and Spine researchers Aakash Agarwal, Ph.D.—has published a retrospective study which makes a case that active apex correction (APC) may reduce the risk of correction loss while a child is growing and therefore, preclude the need for repeated surgeries using traditional growth rods for children suffering from spinal deformity.
Researchers Highlight Benefits of Modified SHILLA Technique
Aakash Agarwal, Ph.D., and his great team of scientists—Loai Aker, M.D. and Alaaedldin Azmi Ahmad, M.D. of Annajah Medical School in Palestine—followed 20 pediatric patients under the age of 8 who were undergoing surgery for spinal deformity—specifically for scoliosis or kyphoscoliosis. The results were published in Global Spine Journal and the team presented follow-up data comparing this technique and traditional growth rods in Spine Surgery and Research.
What did the study show? Simply put, APC may be preferable to promote growth guidance over the traditional SHILLA™ technique, which is currently one of the standard surgical approaches.
When asked about what sparked interest in pursuing this research, Agarwal explained to OTW, “The impetus came from the work of Dr. Alaaedldin Azmi Ahmad, who, in trying to control severe type 1 congenital kyphosis in the thoracolumbar region of children with early onset scoliosis, used a technique which involved putting screws above and below the peaked wedged vertebrae in association with growth rods. After more than 2 years of follow up for 13 patients, he realized that the wedging of the peaked wedged vertebrae dramatically improved.”
Longer Lasting Correction as Children Grow, Fewer Repeat Surgeries
Agarwal and his colleagues explained that using the traditional SHILLA procedure frequently leads to loss of correction due to crankshafting or adding-on. Such phenomenon occurs as the child grows and can result in either return of deformity or loss of the correction previously provided by SHILLA. In addition, traditional SHILLA requires fusion at the apex, and there exists a significant risk of complications due to need for osteotomies on the concave side.
So, the team looked at a modified non-fusion SHILLA procedure, active apex correction (APC) which involves placing pedicle screws both above and below wedged vertebra, on the convex side. In this manner, compensatory pressure can be created on the vertebra via compression of pedicle screws before tightening. This allows for reverse modulation and over time, wedging reduction. It can also provide a foundation for growth guidance at the apex of the curvature.
Importantly, the technique avoided osteotomies and no screws were used on the concave side of the apex. In fact, it only required 2 screws at the apex of the curve, as opposed to 6 screws which are typically used in traditional SHILLA surgery.
Fewer screws, lower cost.
