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Body mass index affects outcomes after vertebral body tethering surgery

Abstract

Purpose

To compare the outcomes of anterior Vertebral Body Tethering (AVBT) surgery between overweight and non-overweight patients.

Methods

AIS/JIS patients with AVBT with 2-year follow-up from a multi-center pediatric spine database were evaluated pre-operatively, 1st post-operative erect, and 2 years post-operatively. ANOVA was used to compare 3 categories of BMI with significance as per Tukey–Kramer HSD post hoc test. Risk of scoliosis progression was analysed with Mid-P exact test.

Results

121 patients (51 underweight, 58 normal, 12 overweight; mean age 12.5 ± 1.6 yr; BMI 18.8 ± 4.6 kg/m2) were identified. Comparing underweight, normal, and overweight groups: mean pre-operative age (13 yr, 13 yr, 12 yr), scoliosis (52°, 50°, 52°), pre-operative kyphosis (29°, 28°, 33°), peri-operative scoliosis correction (44%, 42%, 46%), and complications by 2-year follow-up (23%, 24%, 17%) were similar between groups. There was one broken tether in each of the underweight and normal weight groups. Change in percent scoliosis correction from 1st erect to 2-year post-operative (i.e., growth modulation phase) was not significantly different between groups; however, the risk ratio for scoliosis progression during this period was 4.74 (1.02–22.02; p = 0.04) for overweight patients.

Conclusion

Our findings demonstrate that, as compared to normal weight and underweight patients, overweight patients did not have a statistically significant difference in intra-operative scoliosis correction or in risk of experiencing complication; however, overweight patients had a risk ratio of 4.74 for progression of scoliosis during the growth modulation phase of treatment from first erect radiographs to minimum 2-year follow-up.

Level of evidence

III.

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Data availability

Registry data are available to member institutions. Measurements and analysis done at the IWK Health Centre are on a password protected server. Access may be arranged through application to the REB.

Code availability

Statistical analysis was conducted using SPSS v25 (IBM Corporation, Armonk, NY, USA).

References

  1. El-Hawary R, Chukwunyerenwa C (2014) Update on evaluation and treatment of scoliosis. Pediatr Clin North Am 61:1223–1241. https://doi.org/10.1016/j.pcl.2014.08.007

    Article  PubMed  Google Scholar 

  2. Padhye K, Soroceanu A, Russell D et al (2018) Thoracoscopic anterior instrumentation and fusion as a treatment for adolescent idiopathic scoliosis: a systematic review of the literature. Spine Deform 6:384–390. https://doi.org/10.1016/j.jspd.2017.12.013

    Article  PubMed  Google Scholar 

  3. Hoernschemeyer DG, Boeyer ME, Robertson ME, Loftis CM, Worley JR, Tweedy NM, Gupta SU, Duren DL, Holzhauser CM, Ramachandran VM (2020) Anterior vertebral body tethering for adolescent scoliosis with growth remaining: a retrospective review of 2 to 5-year postoperative results. J Bone Joint Surg Am 102(13):1169–1176. https://doi.org/10.2106/JBJS.19.00980

    Article  PubMed  Google Scholar 

  4. Newton PO, Bartley CE, Bastrom TP et al (2020) Anterior spinal growth modulation in skeletally immature patients with idiopathic scoliosis. J Bone Jt Surg 102:769–777. https://doi.org/10.2106/jbjs.19.01176

    Article  Google Scholar 

  5. CDC (2000) Centers for Disease Control and Prevention BMI-for-age charts, United States. https://www.cdc.gov/growthcharts/clinical_charts.htm. Accessed 8 Mar 2021

  6. Li Y, Binkowski L, Grzywna A et al (2017) Is obesity in adolescent idiopathic scoliosis associated with larger curves and worse surgical outcomes? Spine (Phila Pa 1976) 42:E156–E162. https://doi.org/10.1097/BRS.0000000000001721

    Article  Google Scholar 

  7. Goodbody CM, Sankar WN, Flynn JM (2017) Presentation of adolescent idiopathic scoliosis: the bigger the kid, the bigger the curve. J Pediatr Orthop 37:41–46. https://doi.org/10.1097/BPO.0000000000000580

    Article  PubMed  Google Scholar 

  8. Hershkovich O, Friedlander A, Gordon B et al (2014) Association between body mass index, body height, and the prevalence of spinal deformities. Spine J 14:1581–1587. https://doi.org/10.1016/j.spinee.2013.09.034

    Article  PubMed  Google Scholar 

  9. McClendon J, Smith TR, Thompson SE et al (2014) The impact of body mass index on hospital stay and complications after spinal fusion. Neurosurgery 74:42–50. https://doi.org/10.1227/NEU.0000000000000195

    Article  PubMed  Google Scholar 

  10. Gilbert SR, Savage AJ, Whitesell R et al (2015) BMI and magnitude of scoliosis at presentation to a specialty clinic. Pediatrics 135:e1417–e1424. https://doi.org/10.1542/peds.2014-2000

    Article  PubMed  Google Scholar 

  11. Margalit A, McKean G, Constantine A et al (2017) Body mass hides the curve: Thoracic scoliometer readings vary by body mass index value. J Pediatr Orthop 37:e255–e260

    Article  PubMed  PubMed Central  Google Scholar 

  12. Hardesty CK, Poe-Kochert C, Son-Hing JP et al (2013) Obesity negatively affects spinal surgery in idiopathic scoliosis. Clin Orthop Relat Res 471:1230–1235. https://doi.org/10.1007/s11999-012-2696-6

    Article  PubMed  Google Scholar 

  13. Matusik E, Durmala J, Matusik P et al (2013) Severity of spine deformity in children and adolescents with idiopathic scoliosis is associated with nutritional status and body composition. In: 6th International Conference on Children’s Bone Health. Bone Abstracts (2013) 2, Rotterdam, The Netherlands, pp 151

  14. Basques BA, Bohl DD, Golinvaux NS et al (2015) Patient factors are associated with poor short-term outcomes after posterior fusion for adolescent idiopathic scoliosis. Clin Orthop Relat Res 473:286–294. https://doi.org/10.1007/s11999-014-3911-4

    Article  PubMed  Google Scholar 

  15. Newton PO, Bastrom TP, Yaszay B (2017) Patient-specific risk adjustment improves comparison of infection rates following posterior fusion for adolescent idiopathic scoliosis. J Bone Jt Surg Am 99:1846–1850. https://doi.org/10.2106/JBJS.16.01442

    Article  Google Scholar 

  16. Minhas SV, Chow I, Feldman DS et al (2016) A predictive risk index for 30-day readmissions following surgical treatment of pediatric scoliosis. J Pediatr Orthop 36:187–192. https://doi.org/10.1097/BPO.0000000000000423

    Article  PubMed  Google Scholar 

  17. Snowden RD, Prusick VW, Oeffinger DJ et al (2019) Increased acute postoperative wound problems following spinal fusion in overweight patients with adolescent idiopathic scoliosis. J Pediatr Orthop Part B 28:374–379. https://doi.org/10.1097/BPB.0000000000000610

    Article  Google Scholar 

  18. Chan CYW, Mohamad SM, Tan SH et al (2019) Do overweight adolescent idiopathic scoliosis (AIS) patients have an increased perioperative risk for posterior spinal fusion (PSF) surgery?: A propensity score matching analysis of 374 AIS patients. Spine (Phila Pa 1976) 44:389–396. https://doi.org/10.1097/BRS.0000000000002853

    Article  Google Scholar 

  19. Bjerke BT, Saiyed R, Cheung ZB et al (2017) Does adolescent obesity affect surgical presentation and radiographic outcome for patients with adolescent idiopathic scoliosis? J Pediatr Orthop Part B 26:53–58. https://doi.org/10.1097/BPB.0000000000000351

    Article  Google Scholar 

  20. Smith JT, Johnston C, Skaggs D et al (2015) A new classification system to report complications in growing spine surgery: a multicenter consensus study. J Pediatr Orthop 35:798–803. https://doi.org/10.1097/BPO.0000000000000386

    Article  PubMed  Google Scholar 

  21. Dodwell ER, Pathy R, Widmann RF et al (2018) Reliability of the modified Clavien-Dindo-Sink complication classification system in pediatric orthopaedic surgery. JBJS Open Access 3:e0020. https://doi.org/10.2106/jbjs.oa.18.00020

    Article  PubMed  PubMed Central  Google Scholar 

  22. Tarrant RC, Queally JM, Moore DP et al (2018) Prevalence and impact of low body mass index on outcomes in patients with adolescent idiopathic scoliosis: a systematic review. Eur J Clin Nutr 72:1463–1484. https://doi.org/10.1038/s41430-018-0095-0

    Article  PubMed  Google Scholar 

  23. Stokes IAF (2002) Mechanical effects on skeletal growth. J Musculoskelet Neuronal Interact 2:277–280

    CAS  PubMed  Google Scholar 

  24. Jain MJ, Inneh IA, Zhu H et al (2020) Tension Band Plate (TBP)-guided hemiepiphysiodesis in blount disease: 10-year single-center experience with a systematic review of literature. J Pediatr Orthop 40:e138–e143. https://doi.org/10.1097/BPO.0000000000001393

    Article  PubMed  Google Scholar 

  25. Burghardt RD, Herzenberg JE, Andre S et al (2018) Treatment failures and complications in patients with Blount disease treated with temporary hemiepiphysiodesis: a critical systematic literature review. J Pediatr Orthop Part B 27:522–529. https://doi.org/10.1097/BPB.0000000000000523

    Article  Google Scholar 

  26. Oto M, Yilmaz G, Bowen JR et al (2012) Adolescent Blount disease in obese children treated by eight-plate hemiepiphysiodesis. Eklem Hast ve Cerrahisi 23:20–24

    Google Scholar 

  27. Shalitin S, Gat-Yablonski G (2021) Associations of obesity with linear growth and puberty. Horm Res Paediatr. https://doi.org/10.1159/000516171

    Article  PubMed  Google Scholar 

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Acknowledgements

Pediatric Spine Study Group: Abdullah Saad Abdulfattah Abdullah, Edward Ahn, Behrooz Akbarnia, Harry Akoto, Stephen Albanese, Jason Anari, John Anderson, Richard Anderson, Lindsay Andras, Jennifer Bauer, Laura Bellaire, Randy Betz, Craig Birch, Laurel Blakemore, Oheneba Boachie-Adjei, Chris Bonfield, Daniel Bouton, Felix Brassard, Douglas Brockmeyer, Jaysson Brooks, David Bumpass, Pat Cahill, Olivier Chemaly, Jason Cheung, Kenneth Cheung, Robert Cho, Tyler Christman, Eduardo Colom Beauchamp, Daniel Couture, Haemish Crawford, Alvin Crawford, Benny Dahl, Gokhan Demirkiran, Dennis Devito, Mohammad Diab, Hazem El Sebaie, Ron El-Hawary, John Emans, Mark Erickson, Jorge Fabregas, Frances Farley, David Farrington, Graham Fedorak, Ryan Fitzgerald, Nicholas Fletcher, Lorena Floccari, Jack Flynn, Peter Gabos, Adrian Gardner, Sumeet Garg, Frank Gerow, Michael Glotzbecker, Jaime Gomez, David Gonda, Tenner Guillaume, Purnendu Gupta, Kyle Halvorson, Kim Hammerberg, Christina Hardesty, Daniel Hedequist, Michael Heffernan, John Heflin, Ilkka Helenius, Jose Herrera, Grant Hogue, Josh Holt, Jason Howard, Michael Timothy Hresko, Steven Hwang, Stephanie Ihnow, Brice Ilharreborde, Kenneth Illingworth, Viral Jain, Andrew Jea, Megan Johnson, Charles Johnston, Morgan Jones, Judson Karlen, Lawrence Karlin, Danielle Katz, Noriaki Kawakami, Brian Kelly, Derek Kelly, Raymond Knapp, Paul Koljonen, Kenny Kwan, Hubert Labelle, Robert Lark, A. Noelle Larson, William Lavelle, Lawrence Lenke, Sean Lew, Gertrude Li, Craig Louer, Scott Luhmann, Jean-Marc Mac-Thiong, Stuart Mackenzie, Erin MacKintosh, Francesco Mangano, David Marks, Sanchez Marquez, Jonathan Martin, Jeffrey Martus, Antonia Matamalas, Oscar Mayer, Richard McCarthy, Amy McIntosh, Jessica McQuerry, Jwalant Mehta, Lionel Metz, Daniel Miller, Firoz Miyanji, Greg Mundis, Josh Murphy, Robert Murphy, Karen Myung, Susan Nelson, Peter Newton, Matthew Newton Ede, Cynthia Nguyen, Susana Nunez, Matthew Oetgen, Timothy Oswald, Jean Ouellet, Josh Pahys, Kathryn Palomino, Stefan Parent, Alejandro Peiro Garcia, Ferran Pellise, Joseph Perra, Jonathan Phillips, Javier Pizones, Selina Poon, Nigel Price, Norman Ramirez-Lluch, Brandon Ramo, Gregory Redding, Todd Ritzman, Luis Rodriguez, Juan Carlos Rodriguez-Olaverri, David Roye, Benjamin Roye, Lisa Saiman, Amer Samdani, Francisco Sanchez Perez-Grueso, James Sanders, Jeffrey Sawyer, Christina Sayama, Michael Schmitz, Jacob Schulz, Richard Schwend, Suken Shah, Jay Shapiro, Harry Shufflebarger, David Skaggs, Kevin Smit, John Smith, Brian Snyder, Paul Sponseller, George Stephen, Joe Stone, Peter Sturm, Hamdi Sukkarieh, Ishaan Swarup, Michal Szczodry, John Thometz, George Thompson, Tanaka Tomoko, Walter Truong, Raphael Vialle, Michael Vitale, John Vorhies, Eric Wall, Shengru Wang, Bill Warner, Stuart Weinstein, Michelle Welborn, Klane White, David Wrubel, Nan Wu, Kwadwo Yankey, Burt Yaszay, Muharrem Yazici, Terry Jianguo Zhang.

Funding

No funding was received for this study.

Author information

Authors and Affiliations

Authors

Consortia

Contributions

AM, SP, FM, KS, JM, RB, NAK, Pediatric Spine Study Group, RE-H contributed on design or the acquisition, analysis, or interpretation of data, drafted the work or revised it critically, approved, accountable.

Corresponding author

Correspondence to Ron El-Hawary.

Ethics declarations

Conflict of interest

Amir Mishreky has nothing to disclose. Stefan Parent reports personal fees from EOS-imaging, personal fees from Spinologics, personal fees from K2M, personal fees from EOS-imaging, personal fees from Medtronic, personal fees from DePuy Synthes Spine, other from Academic Research chair in spine deformities of the CHU Sainte-Justine (DePuy), grants from DePuy Synthes Spine, grants from Canadian Institutes of Health Research, grants from Pediatric Orthopaedic Society of North America, grants from Scoliosis Research Society, grants from Medtronic, grants from EOS imaging, grants from Canadian Foundation for Innovation, grants from Setting Scoliosis Straight Foundation, grants from Natural Sciences and Engineering Council of Canada, grants from Fonds de recherche Québec—Santé, grants and other from Orthopaedic Research and Education Foundation, other from DePuy Synthes, other from Medtronic, other from Orthopaediatrics, from null, outside the submitted work. Firoz Miyanji consults for Zimmer Biomet. Kevin Smit receives grant from Zimmer Biomet. Joshua Murphy consults for OrthoPediatrics, Depuy Synthes Spine and is a member of the physician advisory board. Riley Bowker has nothing to disclose. Nedal Al Khatib has nothing to disclose. Pediatric Spine Study Group reports grants from Pediatric Orthopaedic Society of North America, grants from Food and Drug Administration, grants from NuVasive, grants from DePuy Synthes Spine, grants from Children’s Spine Foundation, and grants from Growing Spine Foundation. Ron El-Hawary reports grants and personal fees from Depuy Synthes Spine, grants and personal fees from Medtronic Spine, personal fees and other from Orthopediatrics, other from Pediatric Spine Foundation, other from Scoliosis Research Society, personal fees from Wishbone Medical, personal fees from Globus Medical, outside the submitted work.

Ethical approval

This work is a sub-study of the Pediatric Spine Study Group Registry which was approved by the Research Ethics Board at the IWK Health Centre (#1002256) in accordance with the ethical standards outlined in the Tri-Council Policy Statement and the 1964 Declaration of Helsinki and its later amendments.

Consent to participate

All research participants or their legal guardians provided written consent to be a part of the registry and have the data collected be used in ongoing research on scoliosis.

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Not applicable.

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Mishreky, A., Parent, S., Miyanji, F. et al. Body mass index affects outcomes after vertebral body tethering surgery. Spine Deform 10, 563–571 (2022). https://doi.org/10.1007/s43390-021-00455-8

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  • DOI: https://doi.org/10.1007/s43390-021-00455-8

Keywords

  • Vertebral body tethering
  • VBT
  • Growth modulation
  • Scoliosis
  • BMI
  • Obesity