Early Onset Scoliosis (EOS)
Conditions
Keywords
APC, EOS, Active Apex Correction, Early Onset Scoliosis, Scoliosis
Brief summary
The primary objective of this study is to evaluate the early results of Active Apex Correction (APC) technique for managing early onset scoliosis.
Detailed description
Early onset scoliosis (EOS) presents a significant clinical challenge due to progressive spinal deformity during critical periods of spinal and thoracic growth. Inadequate management may result in thoracic insufficiency, impaired pulmonary development, and long-term cardiopulmonary morbidity. Achieving deformity control while preserving spinal growth remains the primary treatment goal. Conservative strategies such as bracing and serial casting may delay progression but are often insufficient, necessitating surgical intervention.Early definitive spinal fusion arrests spinal growth and causes truncal shortening. Growth-friendly, non-fusion techniques preserve spinal growth while controlling deformity. Traditional growing rods (TGR) require repeated surgical lengthening, resulting in high complication risks including infection, implant failure, and unplanned reoperations. Repeated distractions may lead to unintended spinal autofusion, compromising growth potential. Magnetically controlled growing rods reduce repeated surgeries but remain costly with mechanical failure risks. The Shilla system allows spinal growth but faces loss of correction and implant failure. Active Apex Correction (APC) is a relatively novel growth-friendly surgical technique, first innovated approximately 16 years ago, gaining increasing international interest recently. APC, a Shilla modification, addresses limitations of existing growth-preserving strategies. APC employs a single surgical procedure with unilateral convex-side compression at the curve apex, allowing guided spinal growth while avoiding concave-side instrumentation, osteotomies, and repeated lengthening procedures. This approach may reduce operative time, implant density, infection risk, and treatment cost. However, despite theoretical advantages, clinical data on APC remain limited. Therefore, evaluating radiographic correction, growth preservation, and clinical outcomes with APC is necessary to define its role in managing EOS.
Interventions
PROCEDUREActive Apex Correction (APC)
• Active Apex Correction (APC) begins with the identification of the curve apex and the selection of upper and lower "foundation" vertebrae, where pedicle screws are placed on the convex side only, above and below the most wedged vertebrae. No screws are inserted on the concave side, avoiding the need for osteotomies at the apex. The rods are then connected to both upper and lower foundation constructs, contoured to maintain appropriate sagittal alignment.
Sponsors
Assiut University
Study design
Allocation
NA
Intervention model
SINGLE_GROUP
Primary purpose
TREATMENT
Masking
NONE
Intervention model description
* Active Apex Correction (APC) begins with the identification of the curve apex and the selection of upper and lower "foundation" vertebrae, where pedicle screws are placed on the convex side only, above and below the most wedged vertebrae. No screws are inserted on the concave side, avoiding the need for osteotomies at the apex. The rods are then connected to both upper and lower foundation constructs, contoured to maintain appropriate sagittal alignment. * To permit continued spinal growth, controlled sliding is achieved either using domino connectors or specialized sliding screws. The convex-side screws are compressed before final tightening. This compression applies targeted pressure to the vertebral body, promoting gradual vertebral remodulation (reverse modulation) and reduction of apical wedging over time. Rod sliding through domino connectors allows continued longitudinal growth, eliminating the need for repeated lengthening surgeries typical of traditional growing rods.
Eligibility
Sex/Gender
ALL
Age
No minimum to 10 Years
Healthy volunteers
No
Inclusion criteria
* All patients with progressive early onset scoliosis (congenital, idiopathic, neuromuscular or syndromic). * Major curve Cobb angle ≥ 40° * Child below 10 years of age or less than Risser grade 2 * No prior scoliosis surgery
Exclusion criteria
* Age above 10 years or more than Risser grade 2. * Operated EOS cases indicated for revision. * Active infection or systemic illness precluding surgery.
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Spinal Length Correction (T1-T12 and T1-S1) in millimeters. | At latest follow-up (1 year postoperative) | Spinal length will be assessed on standing full-spine radiographs at the latest postoperative follow-up. Measurements will include the distance from T1 to T12 and from T1 to S1 in millimeters. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Percentage of correction of the primary curve (%). | one year postoperative | The Cobb angle of the primary scoliotic curve will be measured on preoperative and latest postoperative standing radiographs. The correction will be calculated in Percentage (%). |
| Thoracic Kyphosis Angle (Cobb Method) in degrees | one year postoperative | Thoracic kyphosis will be measured on lateral standing radiographs between T1 and T12 using the Cobb angle method. The angle will be recorded in degrees (°) at the latest postoperative follow-up. |
| Number of Participants with Postoperative Complications. | one year postoperative | All complications (infection, implant failure, neurological deficit, wound issues) within one year postoperative will be recorded. |
Countries
Egypt
Contacts
CONTACTYoussef Sameh Yassin Francis
Outcome results
None listed