BACKGROUND CONTEXT Distraction system either cause immense morbidity to the patient by several consecutive and invasive distraction episodes or are extremely expensive and not immediately affordable for a major of patients worldwide. SHILLA procedure, although it doesn't result in consecutive surgeries, there still remains severe complications of loss of correction or reappearance of deformity through crankshafting or adding-on (for eg, distal migration). The main culprit of this complication is the vertebral growth anteriorly at the apex, which mostly remains unmodulated by static fusion posteriorly. The current study presents a modified approach to SHILLA that could help dynamically remodulate, ie, reverse modulate, the apex of the deformity. PURPOSE To determine if active remodulation in the apex of the curve is possible in scoliosis and kyphoscoliosis patients, using a modified SHILLA; APC technique for guided growth. STUDY DESIGN/SETTING A retrospective cohort with paired control group. PATIENT SAMPLE Twenty patients paired as follows: (1) 20 adjacent vertebra; (2) 20 compressed wedged vertebra. OUTCOME MEASURES The convex and concave heights of the wedged vertebra were recorded at the time of the surgery and at follow up, both using CT. For comparison a control vertebra was chosen, whose physical dimensions were in par with the wedged vertebra to record the normal growth rate of the particular duration of follow up and age. METHODS The study consisted of 20 patients with either scoliosis or kyphoscoliosis undergoing an index surgery or revision surgery and demonstrating a clear radiographic evidence of vertebral wedging at the apex. All patients were under 8 years of age with Risser less than or equal to 2, and the major Cobb's angle more than 40°. The surgical procedure involved was a modified version of SHILLA, either using rod to screw (SHILLA screws from Medtronic) sliding mechanism or the analogous rod to domino (4.5 mm rod in 5.5 mm domino) sliding mechanism. In this modified technique, the most wedged vertebra was selected followed by insertion of pedicle screws in the convex side of the vertebrae above and below the wedged one. No screws were put on the concave side of the apex. All surgeries were performed under intraoperative neuromonitor and C-arm. Additionally, no cast or brace were used for these patients postoperatively. The patients were followed for a period of at least 8 months. The convex and concave heights of the wedged and control vertebrae were recorded at the time of the surgery and at follow-up, both using CT. The main difference between a wedged vertebra and the control vertebra was the compression forces being applied at the convex end for the wedged vertebra, with the expectations of reducing local longitudinal growth rate. In the control group no such forces were applied. RESULTS The wedged vertebra demonstrated a 17% average increase (p=0.00014) in the proportion of concave to convex heights ratio, whereas the control vertebra didn't show any relative change in the wedged vertebra heights at the follow ups. CONCLUSIONS Active apex correction, instead of apical fusion in SHILLA remodulates the apex vertebra, which may in turn help mitigate loss of correction on long term due to crankshafting and adding-on. FDA DEVICE/DRUG STATUS Unavailable from authors at time of publication.