ArticleSpine deformity2026
Shilla growth guidance system (SGGS) instrumentation with pelvic foundation for severe early-onset neuromuscular spine deformity.
Article in Spine deformity, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
purposeTo present our experience using Shilla Growth Guidance System (SGGS) technology with a solid pelvic foundation in patients with severe early-onset neuromuscular spine deformity.
methodsThe surgical procedure involved a solid instrumented fusion from L5 to the pelvis with iliac screws, with minimal dissection of the spine from L4 to T4, leaving the longitudinal para-spinal muscles intact. Alternating SGGS screws were sequentially placed from L4 to T4 with fluoroscopy and/or computer navigation. This retrospective study from two institutions included surgeries performed by three surgeons. The primary outcomes were the number of revision surgeries and the complication rate; T1-S1 height increase was a secondary outcome.
resultsFor 34 patients, the average age at the initial surgery was 5.9 years and the follow-up was 10 years for surviving patients. Eleven patients were tracheostomy- and ventilator-dependent. The average total number of surgeries/patients was 2.3. The revision surgery rate was 53% (45 revision surgeries in 18 patients, average of 2.5 revision surgeries/patient). 20 patients (59%) had a major complication (modified Clavien-Sink-Dindo classification 3a-5). Nine (26%) had a deep surgical-site (SSI) infection requiring irrigation, debridement, and implant exchange. Thirteen patients died at an average age of 10.7 years, average 4.7 years post-operative, a 38% 10-year mortality and representing the frail nature of this population. Ten of these 13 (77%) deceased patients had no additional surgery after their index surgery, which was one of the major goals of the procedure. Nine of the 34 patients (26%) had a final fusion. The T1-S1 height increased by a mean of 6.7 cm (p < 0.01).
conclusionsSGGS with a solid pelvic foundation is an option for addressing severe spinal deformity for patients with early-onset neuromuscular scoliosis who are too immature for a definitive fusion. For 47% of these patients, only the initial surgical procedure was necessary, thus avoiding serial surgical or clinic lengthening procedures. However, the revision rate of 53% and complication rate of 59% demonstrates the high risks of this procedure in this extremely frail population.
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