1. Analysis of Percentile Weight Changes in Failure To Thrive Children undergoing Growing Rod Insertion.
ICEOS 2012
Walsh A, Lui DF, Kelly M, O'Neill F, McDevitt F, Harrington M,
Noel J, Kiely PJ
Our Lady’s Children’s Hospital Crumlin, Dublin, Ireland

2. Introduction Traditionally classified by subtype:
Neuromuscular
Congenital
Idiopathic
Early Onset Scoliosis
Dickson et al
0-5y
Heterogenous group
Early Onset Scoliosis can be challenging. It can have a variety of aetiology including neuromuscular disorders, Congenital Hemivertebrae and idiopathic
These children characteristically have poor nutritional status and many lie below the 5th percentile for weight: Commonly reffered to as Failure to thrive

3. Issues in Early Onset Scoliosis
Thoracic Insufficiency Syndrome
Coined by Campbell et al
Pulmonary Function continues to develop until the age of 8y
Role of chest wall and spine are combined in development of child
Failure to thrive
Poor nutritional status due to an increased energy expenditure
<5th Weight Percentile
Characteristically poor nutritional status¹
1 DL Skaggs, WN Sankar,J Albrektson, TAL.Wren,RM. Campbell, Weight Gain Following Vertical Expandable Prosthetic Titanium Ribs Surgery in Children With Thoracic Insufficiency Syndrome SPINE Volume 34, Number 23, pp 2530–2533

4. Objectives of Treatment
First Line Treatment: Body Cast and Bracing
Surgical:
Early Fusion vs Growing Rods?
Modern techniques aim to stabilise spine without hindering growth
Growing Rods
Spinal Rods (multiple types)
Vertical Expandible Prosthetic Titanium Rib (VEPTR)
Aim to reach maturity and plan elective Spinal Fusion

5. Objective of study
To Evaluate the percentile weight changes of patients pre and post insertion of the growing spinal instrumentation
Focus on Children with Failure To Thrive (<5th Percentile)

6. Methods Retrospective chart review 2007-2012 51 Patients
Pre- and post- operative percentile weights were calculated:
Online paediatric centile calculator
Centers for Disease Control and Prevention: BMI Percentile Calculator for Child and Teen English Version. BMI Percentile Calculator for Child and Teen English Version]. Available from: Weight of instrumentation was subtracted from weight gain observed (Average Equipment Weight – 0.1kg)
Cobb Angles
Operative morbidity
Statistical Analysis by SPS 16.0 (IBM)

7. Results 21 male; 30 female Avg Age 8.62 (Range= 3-15)
84% Complete data (43 of 51)
Average follow up was 19 months (range 6-48 months)
Age Range:
Adolescents – PH: 15yrs at insertion, Comorbidities – Horseshoe Kidney and hydronephrosis, Previous Acute Renal Failure and Von Williebrand Disease
- SLN: 14yrs at insertion, Comorbidities – Factor 12 Deficiency. Dropped from 68th Centile to the 51st
- AMcN: 15 yrs at insertion, Comorbidities – Spinal Muscular Atrophy, Dropped from the 31st Centile to the 3rd

8. Aetiology Number Of Children Diagnosis
EOS 23, , NM 14, Congenital 13, Atypical 1
Diagnosis

9. Instrumentation
Number Of Children

10. Cobb Angle
P < 0.01
Cobb Angle
66 to 41
Cobb Preop
Cobb Postop

11. Centile Weight Change Box plot
Weight Centile
25 to 35
Weight %ile Preop
Weight %ile Postop

13. Subgroup: Failure To Thrive
13 patients < 5th Percentile Weight
Status (Units)
Percentile: 3.2 to 7.2 (Range 3-20)
18.4kg to 24 kg
4 of 13 improved; The rest stayed on same centile
P<0.01
P=0.05

14. Complications of Growing Rod Insertion

15. Case EM Spina Bifida

16. Case : Growing Rods
PREOP
Sitting
Prone

17. Case : Growing rods
PREOP

18. Growing Rods: VEPTR
POSTOP

19. Discussion How can we measure post operative outcome?
Percentile Weight gain reflects a positive outcome after spinal growing rod insertion
In patients with TIS may reflect decreased energy expenditure assoc with cardiopulmonary function
Limitations:
Failure to thrive (<5th Percentile) may not achieve a major percentile advancement
The presence of those 13 children who lay on or below the 5th centile skews our data as any weight gain which they may have experienced would not have registered in the centile chart

20. Conclusion
Early Onset Scoliosis continues to pose significant surgical challenges
Growing Rods allow continued development without fusion
Significant Cobb Angle Improvement
Significant Mean increase in Percentile Weight and Actual weight
Significant Improvement from FTT