title: Growing Rods Versus Shilla Growth Guidance: Better Cobb Angle Correction and T1-S1 Length Increase But More Surgeries.
abstract: METHODS
  Retrospective comparison.
  
  
  OBJECTIVE
  To compare treatment of early-onset scoliosis (EOS) with Shilla growth guidance versus distraction-based dual growing rods (GR).
  
  
  BACKGROUND
  We are not aware of any prior studies comparing the Shilla procedure with other surgical procedures in the treatment of EOS.
  
  
  METHODS
  The authors performed a multicenter case-matched comparison of patients with EOS treated with Shilla versus dual spine-spine GR from 1995 to 2009. A total of 36 Shilla patients from 3 centers were matched with 36 GR patients from the database by age at index surgery (±1 year), preoperative Cobb angle (±15°), and diagnosis (neuromuscular, congenital, idiopathic, or syndromic). Average follow-up was similar between groups (GR, 4.3 years; Shilla, 4.6 years; p = .353).
  
  
  RESULTS
  Average Cobb angle improvement preoperatively to latest follow-up was 36° (range, 72° to 36°) in the GR group versus 23° (range, 69° to 45°) in the Shilla group (p = .0124). T1-S1 length increased 8.8 cm in patients treated with GR, compared with 6.4 cm in Shilla patients (p = .0170). Shilla patients had fewer surgeries (2.8) than patients in the GR group (7.4) (p < .001) but had a higher rate of unplanned surgeries for implant complications (Shilla, 1.3; GR, 0.5; p = .0151). When revisions for implant complications done at the time of scheduled lengthenings and revisions for construct maintenance were included, the groups did not differ significantly in the number of procedures for implant complications (Shilla, 1.4; GR, 1.5; p = .9451). The overall complication rate did not differ significantly between groups (Shilla, 1.9 [range, 0-7]; GR, 1.3 [range, 0-9]; p = .2085).
  
  
  CONCLUSIONS
  The GR group had a greater improvement in Cobb angle and a greater increase in T1-S1 length than Shilla. The GR patients had more surgeries but Shilla patients had more unplanned procedures. The rate of complications overall did not differ significantly between groups.
authors.affiliation: Children's Orthopaedic Center, Children's Hospital Los Angeles, 4650 Sunset Boulevard, MS#69, Los Angeles, CA 90027, USA.
authors.forename: Lindsay M
authors.initials: LM
authors.lastname: Andras
authors.affiliation: Children's Orthopaedic Center, Children's Hospital Los Angeles, 4650 Sunset Boulevard, MS#69, Los Angeles, CA 90027, USA.
authors.forename: Elizabeth R A
authors.initials: ER
authors.lastname: Joiner
authors.affiliation: Department of Orthopaedics, Arkansas Children's Hospital, 1 Children's Way, Slot 839, Little Rock, AR 72202, USA.
authors.forename: Richard E
authors.initials: RE
authors.lastname: McCarthy
authors.affiliation: Department of Orthopaedics, Arkansas Children's Hospital, 1 Children's Way, Slot 839, Little Rock, AR 72202, USA.
authors.forename: Lynn
authors.initials: L
authors.lastname: McCullough
authors.affiliation: Department of Pediatric Orthopaedics, St. Louis Children's Hospital, One Children's Place, Suite 4S60, St. Louis, MO 63110, USA.
authors.forename: Scott J
authors.initials: SJ
authors.lastname: Luhmann
authors.affiliation: Department of Pediatric Orthopaedics, Johns Hopkins Hospital, 1800 Orleans St. Baltimore, MD 21287, USA.
authors.forename: Paul D
authors.initials: PD
authors.lastname: Sponseller
authors.affiliation: Department of Orthopaedics, Boston Children's Hospital, 300 Longwood Avenue, Fegan 2nd Floor, Boston, Massachusetts 02115, USA.
authors.forename: John B
authors.initials: JB
authors.lastname: Emans
authors.affiliation: Children's Orthopaedic Center, Children's Hospital Los Angeles, 4650 Sunset Boulevard, MS#69, Los Angeles, CA 90027, USA.
authors.forename: Kody K
authors.initials: KK
authors.lastname: Barrett
authors.affiliation: Children's Orthopaedic Center, Children's Hospital Los Angeles, 4650 Sunset Boulevard, MS#69, Los Angeles, CA 90027, USA. Electronic address: dskaggs@chla.usc.edu.
authors.forename: David L
authors.initials: DL
authors.lastname: Skaggs
authors.affiliation: Growing Spine Foundation, 555 East Wells St., Suite 1100, Milwaukee, WI, 53202, USA.
keywords: Dual growing rods; Early-onset scoliosis; Shilla