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Exercise Tolerance in Children With Early Onset Scoliosis: Growing Rod Treatment “Graduates”

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Abstract

Study Design

Prospectively enrolled early-onset scoliosis (EOS) patients undergoing growing rod treatment, who have had no surgery for >1 year and/or have received definitive fusion (growing rod “graduates”).

Objectives

To assess oxygen consumption during exercise and determine if a diminished conventional pulmonary function test (PFT) correlates with metabolic, pulmonary, and cardiovascular measures during exercise.

Summary of Background Data

Based on clinical impression and sequential PFT values, EOS patients who have undergone extensive treatment are thought to have limited capacity during exercise. The use of PFTs in this population has been a primary outcome measure of respiratory capacity; however, PFTs are dependent on effort, and thus subjective. This led us to find a new assessment of outcome, to better understand their pulmonary capacity.

Methods

Patients underwent oxygen consumption (VO 2) testing while walking at self-selected speed over-ground and during a graded exercise test. Maximal VO 2 was predicted in those who completed the test to 85% of maximal heart rate (HR). Statistical analysis included Mann-Whitney U test and Spearman correlation coefficient (α = 0.05).

Results

12 patients participated. Over-ground walking showed that EOS graduates chose to walk at the same speed, but at a higher VO 2 Cost (0.28 mL/kg/m) than controls (0.22 mL/kg/m; p <.001). Treadmill exercise testing showed 9 of 12 subjects able to complete the 85% of predicted maximum protocol. The EOS group had lower VO 2 during the final stage (27.9 mL/kg/min) compared to controls (34.2 mL/kg/min; p =.021); however, their heart rate reached the same values. Subjects completing the protocol had lower predicted VO 2 max (38.5 mL/kg/min) compared with controls (45.0 mL/kg/min), but this was not significant.

Conclusions

Although PFT data suggest clinically relevant pulmonary compromise in EOS patients, the current study shows that these children are able to keep up with their peers in daily activities and also have the capacity to exercise.

Level of Evidence

Level II, therapeutic

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Authors and Affiliations

  1. Texas Scottish Rite Hospital for Children, Dallas, TX, 75219, USA

    Kelly A. Jeans MS, Charles E. Johnston MD, Wilshaw R. Stevens Jr. BS & Dong-Phuong Tran MS

Authors
  1. Kelly A. Jeans MS
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  2. Charles E. Johnston MD
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  3. Wilshaw R. Stevens Jr. BS
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  4. Dong-Phuong Tran MS
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Corresponding author

Correspondence to Kelly A. Jeans MS.

Additional information

Author disclosures: KAJ (none); CEJ (personal fees from Medtronic, personal fees from Wolters Kluwer, outside the submitted work); WRS (none); D-PT (none).

There are no outside funding sources for this study. All funding was provided by the Texas Scottish Rite Research Fund.

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Jeans, K.A., Johnston, C.E., Stevens, W.R. et al. Exercise Tolerance in Children With Early Onset Scoliosis: Growing Rod Treatment “Graduates”. Spine Deform 4, 413–419 (2016). https://doi.org/10.1016/j.jspd.2016.06.002

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  • DOI: https://doi.org/10.1016/j.jspd.2016.06.002

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