Apical control in the management of severe early-onset scoliosis

Charles E. Johnston

Research output: Chapter in Book/Report/Conference proceedingChapter

5 Scopus citations


The three-dimensional apical deformity of scoliosis, comprised of apical vertebral rotation and translation into the convex hemithorax, is believed to be an important anatomic factor responsible for respiratory morbidity associated with poorly controlled EOS. Current “growth-friendly” techniques, such as distraction-based spine constructs, are known to have limited ability to control or correct this apical deformity by virtue of spine anchors being limited to end-vertebral segments only and the biomechanical limitations of pure distraction on a three-dimensional deformity. As a result, methods to improve apical control of EOS (e.g., growth-guidance methods [Shilla, modern trolley]) are now more commonly part of the treatment armamentarium. An additional technique, combining apical control with conventional growing rod methodology, is described in this chapter. Serial correction of spine penetration by in situ bending and re-contouring of an apically anchored convex rod combined with standard lengthening is described. Preliminary results in a small, single institution series are encouraging, by demonstrating improved symmetry between concave and convex hemithoraces on imaging studies while permitting continued spine and thoracic volume growth.

Original languageEnglish (US)
Title of host publicationThe Growing Spine: Management of Spinal Disorders in Young Children, Second Edition
PublisherSpringer Berlin Heidelberg
Number of pages9
ISBN (Print)9783662482841, 9783662482834
StatePublished - Jan 1 2015


  • Apical control
  • Axial plane deformity
  • Early-onset spine deformity
  • Growth-friendly instrumentation

ASJC Scopus subject areas

  • General Medicine


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