1. ICEOS 2015
Comparison of Weight Percentile Gain with Growth-Friendly Constructs in Early Onset Scoliosis
Liam Harris BS1, Lindsay M Andras MD1, Paul D Sponseller MD MBA2, John B Emans MD3, Charles Johnston MD4, David L Skaggs MD MMM1
1.Children's Orthopaedic Center, Children's Hospital Los Angeles; 2.Department of Orthopaedic Surgery, Johns Hopkins Childrens Hospital, Johns Hopkins University; 3.Department of Orthopaedic Surgery, Boston Children’s Hospital, Harvard Medical School; 4. Department of Orthopaedic Surgery, Texas Scottish Rite Hospital for Children, University of Texas Southwestern

2. Disclosures Liam Harris BS – None
Lindsay M. Andras MD – Eli Lilly (c); Orthobullets (f)
Paul D. Sponseller MD, MBA –DePuy (a, b, f); Globus Medical (f); Journal of Bone and Joint Surgery (e); Journal of Bone and Joint Surgery Oakstone Medical (f); Scoliosis Research Society (e)
John Emans MD – Journal of Children’s Orthopedics (e); Medtronic (b); Synthes (b, f)
Charles Johnston MD – Medtronic (f); Journal of Children’s Orthopedics (e); Pediatric Orthopaedic Society of North America (e); Saunders/Mosby-Elsevier (f); Scoliosis Research Society (e)
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 (f)
Grants/Research Support
Consultant
Stock/Shareholder
Speakers’ Bureau
Editorial/Governing Board
Other Financial Support

3. Background
Early Onset Scoliosis is frequently associated with thoracic insufficiency resulting in malnourishment and low percentile weights1,2
Given the difficulties measuring improvement of lung function, weight gain following surgery offers an alternative metric for patient well-being3
Previous studies have demonstrated significant increases in weight following surgery with growth friendly implants4,5

4. Guided Growth Construct
Objective
To compare improvement in nutritional status in EOS patients following surgical treatment with various growth friendly constructs, focusing on underweight patients (<20th percentile)
Growing
Rods
Guided Growth Construct
VEPTR

5. Methods
Retrospective review of Early Onset Scoliosis patients treated surgically with growth-friendly constructs from a multicenter database
Patients with low weight percentile (<20th) at index surgery
Patients with index instrumentation at ≥ 10 years of age or with less than 2 year follow up were excluded
Statistical significance analyzed via t-test

6. Results 267 patients met inclusion criteria:
No significant difference between the groups in:
age at instrumentation
preoperative major curve
length of follow up
etiology
267 patients met inclusion criteria:
Mean Patient Age at Index Surgery – 5.6 years
Mean Follow-up – 5.8 years
Preoperative Patients below 20th Percentile – 55.4%
Etiologies
Congenital – 77
Neuromuscular – 66
Syndromic 79
Idiopathic – 52

7. Results
Change in Weight Percentile Among Low Weight (<20th Percentile) Preoperative Patients
Group
Patients
Pre-Op Weight Percentile
Final Weight Percentile
Change in Weight Percentile
Growing Rods Spine Anchor
N=99
5.07%
18.16%
+13.09%
Growing Rods Rib Anchor
N=15
5.14%
14.71%
+9.58%
VEPTR
N=25
5.36%
10.70%
+5.34%
Guided Growth Construct
N=14
6.89%
10.24%
+3.35%
Total
N=153
5.29%
15.87%
+10.58%

8. Results
Change in Weight Percentile Among Low Weight (<20th Percentile) Preoperative Patients

9. Discussion
Overall, treatment of EOS with growth friendly constructs resulted in an increase in weight percentile
Idiopathic cases demonstrated the largest increase in weight percentile (mean=15.90%) compared to other etiologies though the difference between groups was not statistically significant (p=0.63)
There was no significant correlation between age at surgery, and change in weight percentile (p=0.09)

10. Conclusion
For underweight patients (<20th Percentile), all patients had a mean increase in weight
There were no significant differences in change in weight percentile between growing rods, VEPTR or guided growth constructs

11. References
Campbell RM Jr, Smith MD, Mayes TC, Mangos JA, Willey-Courand DB, Kose N, Pinero RF, Alder ME, Duong HL, Surber JL. The characteristics of thoracic insufficiency syndrome associated with fused ribs and congenital scoliosis. J Bone Joint Surg Am Mar;85-A(3): PubMed PMID:
Atkinson SA, Abrams SA. Introduction. Symposium: Pediatric pulmonary insufficiency: nutritional strategies for prevention and treatment. J Nutr Mar;131(3):933S-934S. PubMed PMID:
Skaggs DL, Sankar WN, Albrektson J, Wren TA, Campbell RM. Weight gain following vertical expandable prosthetic titanium ribs surgery in children with thoracic insufficiency syndrome. Spine (Phila Pa 1976) Nov 1;34(23): doi: /BRS.0b013e3181bd09f5. PubMed PMID:
Dede O, Motoyama EK, Yang CI, Mutich RL, Walczak SA, Bowles AJ, Deeney VF. Pulmonary and Radiographic Outcomes of VEPTR (Vertical Expandable Prosthetic Titanium Rib) Treatment in Early-Onset Scoliosis. J Bone Joint Surg Am Aug 6;96(15): [Epub ahead of print] PubMed PMID:
Myung KS, Skaggs DL, Thompson GH, Emans JB, Akbarnia BA; Growing Spine Study Group. Nutritional improvement following growing rod surgery in children with early onset scoliosis. J Child Orthop May;8(3): doi: /s z. Epub 2014 Apr 24. PubMed PMID: ; PubMed Central PMCID: PMC