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Nutritional Improvement Following Growing Rod Surgery in Children with Early Onset Scoliosis: Paper #83

Myuna, Karen MD; Skaggs, David L. MD; Thompson, George H. MD; Akbarnia, Behrooz A. MD; Growing Spine Study Group

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Summary: We examine the preoperative nutritional status, as a marker of pulmonary status, in children with EOS and the effect of growing rod surgery on this status. After surgery, there was a significant improvement in nutritional status in approximately 50% of patients. Yet, children less than 4 years old did not gain weight. Instead, improvement was greatest at age 4 and decreased in a linear fashion as age increased thereafter.

Introduction: Children with severe early onset scoliosis (EOS) often have poor nutritional status as the energy expenditure of breathing approaches the nutritional gain of eating. The use of VEPTR in children with EOS has been shown to improve their weight. The purposes of this study are to evaluate the nutritional status of children with EOS and determine the effect of treatment with growing rods.

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Methods: Data was retrospectively collected on 88 patients with EOS treated with growing rods at seven different institutions. Mean age at surgery was 5.8 years, and mean Cobb angle was 75 degrees. All patients were followed for a minimum of 2 years (mean follow‐up of 4.1 years). Preoperative weights were converted to normative percentiles based on the patients' age and gender.

Results: Preoperatively, 47% (41/88) of our patients were <5 percentile for weight, meeting the criteria for failure to thrive. There is a significant increase in the mean weight percentiles at latest follow‐up (p= 0.004). 49% of the patients gained weight an average of 18 percentile. A significant relationship exists between age at initial surgery and percentile weight gain (p<0.005). (Figure) This relationship was not confounded by preoperative weight, preoperative Cobb angle, or years of followup (p>0.05). The average absolute weight gain at final follow‐up was 12.3 kg (range, 0.3‐41.3 kg).

Conclusion: Following treatment of EOS with growing rods there was significant improvement in nutritional status in approximately 50% of patients, similar to that reported with VEPTR. These findings support the theory that growing rods improve pulmonary status in children with EOS, as nutritional improvement is one outcome of improved pulmonary status. The relationship between age at initial surgery and nutritional improvement is intriguing.

Significance: Growing rod surgery in children with early onset scoliosis improves nutritional status.

The FDA has not cleared the drug and/or medical device for the use described in this presentation (i.e., the drug or medical device is being discussed for an ‘off label’ use).

© 2010 Lippincott Williams & Wilkins, Inc.

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