1. ICEOS 2016
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); Biomet & Medtronic (d); Orthobullets (f); SRS, POSNA, JPO (e)
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); SRS (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); SRS(e)
David L. Skaggs MD MMM – Ellipse, POSNA (a), GSSG & GSF (e); SRS (a, e); ZimmerBiomet (b, d, e); Medtronic (b, d, e); Zipline Medical, Inc. (b, c); Orthobullets (b, c); Grand Rounds (b); Green Sun Medical (b, c); Johnson & Johnson (d); Wolters Kluwer Health - Lippincott Williams & Wilkins; Biomet Spine (e)
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
Growing Rods
spine anchors
Growing Rods
rib anchors
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 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 287 patients met inclusion criteria:
Mean Patient Age at Index Surgery: 5.4 years
Mean Follow-up: 5.8 years
Preoperative Patients below 20th Percentile: 56.5% (162/287)
Etiologies
Congenital – 85
Neuromuscular – 69
Syndromic - 79
Idiopathic – 52

7. Results: <20th Weight Percentile
162 patients
Mean Preoperative weight percentile: 5.3%
Patients who increased in weight percentile:
47.5 (77/162)
Mean Change in Weight Percentile: (+)10.5%
Etiologies: Congenital=53;
Neuromuscular=40; Syndromic=45;
Idiopathic=23

8. Results: 20th-50th Weight Percentile
63 patients
Mean Change in Weight Percentile:
(+)6.6% (p=0.106)
Etiologies
Congenital=17
Neuromuscular=18
Syndromic=16
Idiopathic =12

9. Results:>50th weight percentile
62 patients
Mean Change in Weight Percentile:
(-)15.5% (p=0.001)
Etiologies: Congenital=15;Neuromuscular=11;
Syndromic=18;Idiopathic=17

10. Results: <20th Weight Percentile
Change in Weight Percentile by Implant
No significant difference between constructs (p=0.162)
No significant difference between diagnoses (p=0.583)

11. Results: <20th Weight Percentile
Change in Weight Percentile by Diagnosis
No significant difference between constructs (p=0.170)
No significant difference between diagnoses (p=0.583)

12. Conclusion
<20th Weight Percentile demonstrated an increase in weight percentile (p=0.001) with mean gain of +10.5%
No significant differences in change in weight percentile between implant types (p=0.162)
No significant differences in change in weight percentile between diagnoses (p=0.583)
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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