1. In the first 5 years of Treatment, the Charges for Guided Growth Constructs are 30% less than Growing Rods Lindsay M. Andras MD 1, Liam Harris BS 1, Scott Yang MD 1, Alexander Broom BA 1, Howard Park MD 2, McKenna Archer MS 1, David L. Skaggs MD MMM 1 1.Children’s Orthopaedic Center, Children's Hospital Los Angeles, 2.Orthopaedics, University of California Los Angeles 1 ICEOS 2015

2. Disclosures Lindsay M. Andras MD – Eli Lilly (c); Orthobullets (e) Liam Harris BS - None Scott Yang MD – None Alexander Broom BA – None Howard Park MD – None McKenna Archer MS – None David L. Skaggs MD MMM – – SRS & POSNA (a); Biomet; Medtronic; Orthobullets; Grand Rounds (b); Zipline Medical, Inc. (b & c); Biomet; Medtronic; Johnson & Johnson (d); Wolters Kluwer Health - Lippincott Williams & Wilkins; Biomet Spine (e) 2 a.Grants/Research Support b.Consultant c.Stock/Shareholder d.Speakers’ Bureau e.Other Financial Support

3. Background Growing rod (GR) instrumentation and guided growth constructs are two alternatives for treatment of severe progressive early onset scoliosis (EOS) Unlike growing rod instrumentation, guided growth constructs do not require routine surgical lengthenings No prior studies have compared the economics of these two alternative treatments for severe EOS 3

4. Objective To investigate the economics of growing rod versus guided growth constructs for the treatment of early onset scoliosis 4 Screws that the rod can slide along Limited fusion at apex to control curve Connectors through which the rods are lengthened Growing Rods Guided Growth Construct

5. Methods Retrospective chart review of EOS patients at a single institution from 2007 to 2014 with either GR or guided growth constructs Patients with less than 2 year follow up were excluded Physician and hospital charges and collections until most recent follow up or time of definitive fusion were examined The charges were averaged per patient Statistical significance analyzed via t-test 5

6. Results 18 patients met the inclusion criteria: GR group - 7 patients Guided growth construct group - 11 patients No significant difference in age at instrumentation, preoperative major curve or length of follow up between the two groups 6 Mean Age of Index Instrumentation Mean Major Preoperative Curve Mean Length of Follow up Growing Rods4.8 yrs 83.6° 4.9 yrs Guided Growth Construct 5.9 yrs 76.5° 4.7 yrs P-Value0.280.400.80

7. Results Mean number of procedures excluding final fusion GR Group: 6.0 procedures Guided Growth Construct Group: 2.1 procedures The mean physician charges, physician collections, and hospital charges were significantly less for the guided growth constructs. 7 Mean Physician Charges Mean Physician Collection Mean Hospital Charges Mean Hospital Collections Growing Rods$52,152$13,438$204,087$52,149 Guided Growth Constructs $21,371$4,871$159,509$30,952 P-Value<0.00010.00040.0410.093

8. Results Mean charges and collections per patient: 8

9. Discussion The smaller number of procedures in the guided growth construct group corresponded to significantly lower physician charges, physician collections, and hospital charges compared to GR group Prior research has demonstrated that GR provide slightly more curve correction and increase in T1-S1 length with intermediate follow up than guided growth constructs 5 However, this has to be weighed against the cost both to the healthcare system and to the patient, resulting from more frequent surgical procedures 9

10. Conclusion Compared with GR instrumentation, the hospital charges, physician charges and hospital collections for treating EOS patients were significantly lower with guided growth constructs 10

11. References 1.Pehrsson K, Larsson S, Oden A, Nachemson A. Long-term follow-up of patients with untreated scoliosis: a study of mortality, causes of death, and symptoms. Spine 1992;17:1091-6. 2.Lloyd-Roberts, GC., Pilcher MF., Structural Idiopathic Scoliosis in Infancy: A Study of the Natural History of 100 Patients. J Bone Joint Surg Br. 1965 Aug;47:520-3 3.McCarthy RE, Luhmann S, Lenke LG. The Shilla growth guidance technique for early onset spinal deformities at two year follow-up: a preliminary report.Spine.2010[in press]. 4.Tolo VT, Skaggs DL. Master Techniques in Pediatric Orthopaedic Surgery.2008.Philadelphia:Lippincott Williams & Wilkins. 5.Andras, LM., Joiner, EJ, McCarthy, RE, Luhmann, SJ, Sponseller, PD; Emans, JB, Barrett, KK, Skaggs, DL,Growing Spine Study Group. Growing Rods vs. Shilla Growth Guidance: Better Cobb Angle Correction and T1-S1 Length Increase but More Surgeries. Spine Deformity, 2015. In press. 11