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BMI change following spinal fusion for neuromuscular scoliosis surgery
Keith D Baldwin1,2, Patrick J Cahill3,4, Paul D Sponseller5
1Division of Orthopaedic Surgery, The Children's Hospital of Philadelphia, Philadelphia, PA, USA. baldwink@email.chop.edu.
Insights
Children with cerebral palsy (CP) who are underweight may gain weight percentile after spinal fusion surgery. This improvement is more pronounced in those with less severe pre-operative scoliosis, suggesting surgery can aid nutritional status in CP patients.
Area of Science:
- Pediatric Orthopedics
- Neurology
- Developmental Pediatrics
Background:
- Children with cerebral palsy (CP) often experience cachexia and low body mass index, impacting their nutritional status.
- Scoliosis is a common comorbidity in children with CP, further complicating nutritional management.
- Previous observations suggested potential weight gain after spinal fusion in underweight children with CP.
Purpose of the Study:
- To investigate the impact of corrective spinal surgery on weight percentile in children with cerebral palsy (CP).
- To determine if pre-operative nutritional status influences post-operative weight changes in this population.
- To assess the correlation between scoliosis correction and weight gain following spinal fusion.
Main Methods:
- A retrospective descriptive, multi-center study analyzed data from a prospective registry of children with CP.
- Weight percentiles were plotted using CP-specific growth charts pre-operatively and at 1, 2, and 5 years post-surgery.
- Patients with less than two years of follow-up, GMFCS III or below, or missing weight data were excluded.
Main Results:
- Patients starting below the 50th percentile for weight showed a statistically significant increase of 12.1 percentiles post-surgery (p < 0.001).
- Patients starting at or above the 50th percentile showed a non-significant average decrease of 2.2 percentiles.
- A residual scoliosis curve of 40° or greater was associated with approximately 13.3 percentile less weight gain compared to better corrections.
Conclusions:
- Corrective spinal surgery may improve weight percentile in underweight children with cerebral palsy (CP).
- The benefits of spinal fusion on weight gain appear more significant for patients with lower pre-operative weight percentiles.
- Suboptimal scoliosis correction (≥40° residual curve) may limit the positive impact of spinal fusion on nutritional status.
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. 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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