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BMI change following spinal fusion for neuromuscular scoliosis surgery

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Abstract

Study design

Retrospective descriptive, multi-center study.

Objectives

We hypothesize that a post-operative weight gain will result in patients who are underweight prior to surgery.

Summary of background data

Cachexia and low body mass index is common among children with cerebral palsy (CP). Many interventions are undertaken to assist the child in nourishment and to obtain a more normal body mass. Additionally, scoliosis is common among children with CP. In our practice we have noted weight gain post operatively in severely underweight children after spinal fusion.

Methods

We underwent a retrospective review of a CP cohort from a multicenter prospective registry. Percentiles on the CP specific growth chart for which each child belonged were plotted based on the patients’ age, weight, gender, GMFCS level, and tube feeding status. We then assessed percentile change in patients between pre-op visit, 1 year, 2 years and for those with available data, 5 years follow up visits. Patients with under two years of follow up, patients with GMFCS III and below, and patients without weight data were excluded.

Results

We identified a total of 211 potentially eligible patients from a multicenter prospective registry. 109 had complete 2 years data to analyze and 37 patients had full 5 years data to analyze. We found that patients under the 50th percentile pre-operatively increased their percentile on the CP growth chart for weight 12.1 percentiles (95% CI 6.7, 17.5 p value < 0.001) whereas patients that began at the 50th percentile or above on average lost 2.2 percentiles (95% CI −6.8, 2.3) though the change was not statistically significant (p value 0.330). These changes appeared stable at 5 years. Although regression analysis showed that Cobb correction and pelvic obliquity correction, and hyperlordosis were not independent predictors of the change, we noted that patients with residual curves after surgery of 40° or more experienced 13.3 percentile less weight gain than those with better corrections.

Conclusions

Patients with CP are at risk for cachexia, malnutrition, reflux and other GI disorders. Data presented here suggests that corrective spinal surgery may improve weight percentile in patients who start out at 50th percentile and lower. Patients with 40° or greater of residual scoliosis may benefit less from spinal fusion than those with a better correction.

Level of evidence

II; Prognostic retrospective cohort study.

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References

  1. Accardo PJ (ed) (2008) Capute and Accardo's Neurodevelopmental Disabilities in Infancy and Childhood, Third Edition. Paul H Brookes Publishing Co, Baltimore MD, p 17

    Google Scholar 

  2. Hägglund G, Pettersson K, Czuba T, Persson-Bunke M, Rodby-Bousquet E (2018) Incidence of scoliosis in cerebral palsy: a population-based study of 962 young individuals. Acta Orthop 89(4):443–447

    Article  Google Scholar 

  3. Stanitski CL, Micheli LJ, Hall JE, Rosenthal RK (1982) Surgical correction of spinal deformity in cerebral palsy. Spine 7(6):563–569

    Article  CAS  Google Scholar 

  4. Watanabe K, Lenke LG, Daubs MD et al (2009) Is spine deformity surgery in patients with spastic cerebral palsy truly beneficial?: a patient/parent evaluation. Spine 34(20):2222–2232

    Article  Google Scholar 

  5. Miyanji F, Nasto LA, Sponseller PD et al (2018) Assessing the risk-benefit ratio of scoliosis surgery in cerebral palsy: surgery is worth it. JBJS 100(7):556–563

    Article  Google Scholar 

  6. Jain A, Sullivan BT, Shah SA et al (2018) Caregiver perceptions and health-related quality-of-life changes in cerebral palsy patients after spinal arthrodesis. Spine 43(15):1052–1056

    PubMed  Google Scholar 

  7. Araújo LA, Silva LR, Mendes FA (2012) Digestive tract neural control and gastrointestinal disorders in cerebral palsy. J Pediatr 88(6):455–464

    Article  Google Scholar 

  8. Jahan I, Muhit M, Karim T et al (2018) What makes children with cerebral palsy vulnerable to malnutrition? Findings from the Bangladesh cerebral palsy register (BCPR). Disabil Rehabil 41(19):2247–2254

    Article  Google Scholar 

  9. Dahlseng MO, Finbråten AK, Júlíusson PB, Skranes J, Andersen G, Vik T (2012) Feeding problems, growth and nutritional status in children with cerebral palsy. Acta Paediatr 101(1):92–98

    Article  Google Scholar 

  10. Kuperminc MN, Stevenson RD (2008) Growth and nutrition disorders in children with cerebral palsy. Dev Disabil Res Rev 14(2):137–146

    Article  Google Scholar 

  11. DeFrancesco CJ, Miller DJ, Cahill PJ, Spiegel DA, Flynn JM, Baldwin KD (2018) Releasing the tether: Weight normalization following corrective spinal fusion in cerebral palsy. J Orthop Surg 26(2):2309499018782556

    Article  Google Scholar 

  12. Pahys J, Samdani A, Kelly MP, et al. Are severely underweight patients with cerebral palsy at a higher risk for complications and poorer outcomes following posterior spinal fusion for scoliosis? In: 23rd International Meeting on Advanced Spinal Techniques. Washington, DC

  13. Group HS. HARMS Study Group (2017) Current HSG Research. https://hsg.settingscoliosisstraight.org/current-hsg-research/

  14. Brooks J, Day S, Shavelle R, Strauss D (2011) Low weight, morbidity, and mortality in children with cerebral palsy: new clinical growth charts. Pediatrics 128(2):e299–e307

    Article  Google Scholar 

  15. Cahill PJ, Warnick DE, Lee MJ et al (2010) Infection after spinal fusion for pediatric spinal deformity: thirty years of experience at a single institution. Spine 35(12):1211–1217. https://doi.org/10.1097/BRS.0b013e3181c212d1(published Online First: Epub Date)

    Article  PubMed  Google Scholar 

  16. Whitaker AT, Sharkey M, Diab M (2015) Spinal fusion for scoliosis in patients with globally involved cerebral palsy: an ethical assessment. J Bone Jt Surg Am 97(9):782–787. https://doi.org/10.2106/JBJS.N.00468(published Online First: Epub Date)

    Article  Google Scholar 

  17. Skaggs DL, Sankar WN, Albrektson J, Wren TA, Campbell RM (2009) Weight gain following vertical expandable prosthetic titanium ribs surgery in children with thoracic insufficiency syndrome. Spine 34(23):2530–2533

    Article  Google Scholar 

  18. Myung KS, Skaggs DL, Thompson GH, Emans JB, Akbarnia BA, Group GSS (2014) Nutritional improvement following growing rod surgery in children with early onset scoliosis. J Child Orthop 8(3):251–256

    Article  Google Scholar 

  19. Coppock JH, Ridolfi DR, Hayes JF, St Paul M, Wilfley DE (2014) Current approaches to the management of pediatric overweight and obesity. Curr Treat Options Cardiovasc Med 16(11):343. https://doi.org/10.1007/s11936-014-0343-0(published Online First: Epub Date)

    Article  PubMed  PubMed Central  Google Scholar 

  20. Allison PD (2002) Missing data. SAGE publications inc, Thousand Oaks

    Book  Google Scholar 

  21. Baldwin KD, Ohman-Strickland P. Missing data in orthopaedic research. University of Pennsylvania. orthopaedic journal 2019, vol 2009. https://upoj.org/wp-content/uploads/v19/v19_17.pdf

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Acknowledgements

We thank Alay Shah for his help with data analysis. On behalf of, Harms Study Group Investigators: Aaron Buckland, MD; New York University. Amer Samdani, MD; Shriners Hospitals for Children—Philadelphia. Amit Jain, MD; Johns Hopkins Hospital. Baron Lonner, MD; Mount Sinai Hospital. Benjamin Roye, MD; Columbia University. Burt Yaszay, MD; Rady Children’s Hospital. Chris Reilly, MD; BC Children’s Hospital. Daniel Hedequist, MD; Boston Children’s Hospital. Daniel Sucato, MD; Texas Scottish Rite Hospital. David Clements, MD; Cooper Bone & Joint Institute New Jersey. Firoz Miyanji, MD; BC Children’s Hospital. Harry Shufflebarger, MD; Nicklaus Children's Hospital. Jack Flynn, MD; Children’s Hospital of Philadelphia. Jahangir Asghar, MD; Cantor Spine Institute. Jean Marc Mac Thiong, MD; CHU Sainte-Justine. Joshua Pahys, MD; Shriners Hospitals for Children—Philadelphia. Juergen Harms, MD; Klinikum Karlsbad-Langensteinbach, Karlsbad. Keith Bachmann, MD; University of Virginia. Larry Lenke, MD; Columbia University. Mark Abel, MD; University of Virginia. Michael Glotzbecker, MD; Boston Children’s Hospital. Michael Kelly, MD; Washington University. Michael Vitale, MD; Columbia University. Michelle Marks, PT, MA; Setting Scoliosis Straight Foundation. Munish Gupta, MD; Washington University. Nicholas Fletcher, MD; Emory University. Patrick Cahill, MD; Children’s Hospital of Philadelphia. Paul Sponseller, MD; Johns Hopkins Hospital. Peter Gabos, MD: Nemours/Alfred I. duPont Hospital for Children. Peter Newton, MD; Rady Children’s Hospital. Peter Sturm, MD; Cincinnati Children’s Hospital. Randal Betz, MD; Institute for Spine & Scoliosis. Ron Lehman, MD; Columbia University. Stefan Parent, MD: CHU Sainte-Justine. Stephen George, MD; Nicklaus Children's Hospital. Steven Hwang, MD; Shriners Hospitals for Children—Philadelphia. Suken Shah, MD; Nemours/Alfred I. duPont Hospital for Children. Tom Errico, MD; Nicklaus Children's Hospital. Vidyadhar Upasani, MD; Rady Children’s Hospital

Funding

This study was supported by funding from the Setting Scoliosis Straight Foundation in support of Harms Study Group research from DePuy Synthes Spine, EOS imaging, K2M, Medtronic, NuVasive and Zimmer Biomet.

Author information

Authors and Affiliations

  1. Division of Orthopaedic Surgery, The Children’s Hospital of Philadelphia, Philadelphia, PA, USA

    Keith D. Baldwin, Patrick J. Cahill, David A. Spiegel & John M. Flynn

  2. Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA

    Keith D. Baldwin, Patrick J. Cahill, David A. Spiegel & John M. Flynn

  3. Division of Pediatric Orthopaedics, Johns Hopkins Hospital, Baltimore, MD, USA

    Paul D. Sponseller

  4. Department of Orthopedic Surgery, University of Virginia, Charlottesville, VA, USA

    Mark F. Abel

  5. Shriners Hospital for Children, Philadelphia, PA, USA

    Josh M. Pahys

Authors
  1. Keith D. Baldwin
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  2. Patrick J. Cahill
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  3. Paul D. Sponseller
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  4. Mark F. Abel
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  5. David A. Spiegel
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  6. John M. Flynn
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  7. Josh M. Pahys
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Consortia

Harms Study Group Investigators

  • Alay Shah
  • , Aaron Buckland
  • , Amer Samdani
  • , Amit Jain
  • , Baron Lonner
  • , Benjamin Roye
  • , Burt Yaszay
  • , Chris Reilly
  • , Daniel Hedequist
  • , Daniel Sucato
  • , David Clements
  • , Firoz Miyanji
  • , Harry Shufflebarger
  • , Jack Flynn
  • , Jahangir Asghar
  • , Jean Marc Mac Thiong
  • , Joshua Pahys
  • , Juergen Harms
  • , Keith Bachmann
  • , Larry Lenke
  • , Mark Abel
  • , Michael Glotzbecker
  • , Michael Kelly
  • , Michael Vitale
  • , Michelle Marks
  • , Munish Gupta
  • , Nicholas Fletcher
  • , Patrick Cahill
  • , Paul Sponseller
  • , Peter Gabos
  • , Peter Newton
  • , Peter Sturm
  • , Randal Betz
  • , Ron Lehman
  • , Stefan Parent
  • , Stephen George
  • , Steven Hwang
  • , Suken Shah
  • , Tom Errico
  •  & Vidyadhar Upasani

Contributions

KDB, PJC, JMP: conception or design of work. KDB, PJC, PDS, MFA, DAS, JMF, JMP: acquisition, analysis, or interpretation of data for the work. KDB, PJC, PDS, MFA, DAS, JMF, JMP: drafting of work or revising it critically for important intellectual content. KDB, PJC, PDS, MFA, DAS, JMF, JMP: final approval of version to be published.

Corresponding author

Correspondence to Keith D. Baldwin.

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IRB approval

Institutional Board Approval was obtained locally at each participating institution with regards to data acquisition and collection.

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Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

The members of the Harms Study Group Investigators mentioned in Acknowledgements section.

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Baldwin, K.D., Cahill, P.J., Sponseller, P.D. et al. BMI change following spinal fusion for neuromuscular scoliosis surgery. Spine Deform 8, 1081–1087 (2020). https://doi.org/10.1007/s43390-020-00109-1

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  • DOI: https://doi.org/10.1007/s43390-020-00109-1

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