Using the Pangea Spine System in the modified Shilla guided growth technique for the treatment of Early-Onset Scoliosis: The Iranian experience

This study aims to assess the safety and reproducibility of the modified Shilla guided growth technique in resource-limited settings, addressing the gap in knowledge regarding its applicability and effectiveness in outreach countries. Six patients diagnosed with early-onset scoliosis (EOS) underwent treatment using the modified Shilla guided growth technique, utilizing the Pangea Spine System instead of the standard recommended instrumentation system. At the time of surgery, the median patient age was 6 years (range: 3–8 years), with a median follow-up period of 6 years (range: 1–11 years). Preoperative and postoperative curve parameters were analyzed to evaluate surgical outcomes. At the final follow-up, the primary spinal curve showed a reduction of 10.2 %, while thoracic kyphosis and lumbar lordosis decreased by approximately 28.4 % and 33.3 %, respectively. The median preoperative T1-S1 height was 233 mm (range: 187–283 mm), which increased to 378 mm (range: 303.6–384 mm) at the latest follow-up, reflecting significant spinal growth of 62.2 %. Rod sliding was observed at both ends of the construct, with a more pronounced displacement at the upper foundation. One patient (17 %) required unplanned revision surgery due to an erroneous apical fusion strategy. This study highlights the need for continuous refinement of surgical techniques and instrumentation to address the unique anatomical and pathological challenges in pediatric spinal surgery, particularly in resource-constrained environments.