According to Gram Research analysis, procedures on malnourished children with early-onset scoliosis led to complications 23.9% of the time, versus 7.5% for well-nourished children. Having three or more growing-rod surgeries also raised risk. The nutrition link needs confirmation in larger studies.
Children with early-onset scoliosis, a spinal curve that appears before age 10, often need several surgeries to lengthen their spines as they grow. Because the curve makes children look shorter than they are, standard weight checks can be misleading. According to Gram Research analysis of a study from 2016 to 2023, researchers corrected each child’s height before every surgery and recalculated nutrition status. Of 86 growing-rod procedures in 53 patients, 14 led to complications. Procedures on children classified as malnourished after the height correction had complications 23.9% of the time, compared with 7.5% for well-nourished children. Having three or more surgeries was also linked to higher risk. The nutrition link did not hold up under a stricter statistical check, so larger studies are needed. Still, the findings suggest that nutrition should be checked before every procedure.
Key Statistics
A 2016 to 2023 retrospective cohort study of 53 patients with early-onset scoliosis found that complications occurred in 23.9% of growing-rod procedures performed on malnourished children, compared with 7.5% in well-nourished children.
In the same study of 86 growing-rod procedures, undergoing three or more surgeries was associated with about 4.6 times the odds of postoperative complications.
Across 86 growing-rod procedures, the overall postoperative complication rate was 16.3%, with 14 procedures resulting in complications.
The Quick Take
- What they studied: Does a child’s nutrition status, measured after correcting for the height lost to a spinal curve, relate to problems after growing-rod surgery, and does having repeated surgeries add to that risk?
- Who participated: 53 children and teens with early-onset scoliosis who had growing-rod surgery between 2016 and 2023. Together they had 86 surgical procedures, and each procedure was analyzed separately.
- Key finding: Complications occurred in 23.9% of procedures done on malnourished children, compared with 7.5% in well-nourished children. Having three or more surgeries was also linked to higher risk. However, the nutrition link was not statistically strong enough once a stricter test was applied, so it remains uncertain.
- What it means for you: For families and care teams, checking nutrition again before each surgery, with height adjusted for the spinal curve, may help identify children who need extra support. These findings come from a small study and should not change treatment on their own.
The Research Details
This was a retrospective cohort study, meaning researchers looked back at medical records of children who had already received growing-rods. Growing-rods are metal rods placed along the spine that are lengthened periodically as the child grows. The team reviewed 53 patients who had 86 procedures in total.
A key challenge was measuring nutrition. Scoliosis shortens a child’s measured height, which can make body mass index (BMI), a common weight-to-height measure, look falsely low or high. To address this, the researchers used a formula called the Ylikoski method to estimate the child’s true height before each procedure, then recalculated BMI and classified nutrition status. Each procedure was linked to whether complications followed.
The researchers used a statistical approach called generalized estimating equations. It accounts for the fact that one child can contribute several procedures, which would otherwise make the results look more certain than they are. They also applied a small-sample correction, a stricter adjustment for studies with limited data.
Because each child had several surgeries, following them over time let researchers see how nutrition changed before each procedure and whether that tracked with problems afterward. Looking at each procedure separately, rather than only at the first surgery, captures the real treatment path more accurately.
Correcting for height is also important. Without it, many children could be wrongly labeled as malnourished or as healthy, which would distort any conclusions about nutrition and surgical risk.
Strengths include the longitudinal design, which tracked children across repeated surgeries, and the statistical methods that account for multiple procedures in the same child. The team also checked their results with a stricter test designed for small samples.
Readers should be cautious. The study is retrospective, so it can show associations but not prove cause and effect. The sample is small, with only 14 procedures involving complications, and the key nutrition result lost statistical significance under the stricter test. The authors themselves state that larger cohorts are needed to confirm these findings.
What the Results Show
Across 86 growing-rod procedures, 14 were followed by a complication, an overall rate of 16.3%. In total, 15 specific complication events were recorded. After correcting for height, 46 procedures were classified as malnourished and 40 as normal nutrition.
Procedures in the malnourished group had a complication rate of 23.9%, compared with 7.5% in the normal nutrition group. This difference was statistically significant in the initial analysis (p = 0.042), which means it was unlikely to be due to chance alone under that test.
In the multivariable analysis, which considers several factors at once, having three or more surgeries was linked to about 4.6 times the odds of complications. Malnutrition was linked to about 3.7 times the odds. The odds ratio for malnutrition was 3.701, with a wide 95% confidence range of 1.006 to 13.613.
However, after the stricter Mancl-DeRouen small-sample correction, the malnutrition association was no longer statistically significant (odds ratio 4.21, 95% confidence range 0.38 to 46.12, p = 0.239). This wide range shows how much uncertainty remains.
The authors suggest that height-adjusted BMI can be used procedure by procedure as an alternative way to track nutrition during long treatment courses. This matters because standard BMI can misclassify children with spinal curves, and repeated checks may reveal changes that a single assessment would miss.
The finding about repeated surgeries is also notable. Children who needed three or more procedures had higher complication risk, which may reflect the cumulative strain of multiple operations, more time in treatment, or underlying health factors that the study did not fully capture.
Previous research has documented that children with spinal deformities and growing-rod treatment face a meaningful rate of complications, and that nutrition is widely recognized as important for surgical healing and recovery in general. This study adds a procedure-level view and highlights the problem of measuring nutrition in children with scoliosis. Its results are consistent with the general idea that poorer nutrition is linked to more problems after surgery, but the statistical uncertainty means this study alone does not settle the question.
The study is retrospective, so it relies on existing medical records and cannot prove that malnutrition caused complications. Some factors may have been recorded inconsistently or missed entirely.
The sample is small. Only 14 procedures had complications, and the main nutrition result did not hold up under the stricter small-sample test. A result like this can easily be influenced by chance or by a few individual cases.
The study also reflects the care and surgical practices of the participating center. Results may differ in other hospitals or regions. The authors note that larger cohorts are needed to confirm these findings.
The Bottom Line
Based on this study, checking nutrition before each growing-rod procedure appears reasonable, using height adjusted for the spinal curve to avoid misclassification. Confidence in this recommendation is moderate, since it aligns with general surgical practice but rests on a small study.
The link between malnutrition and complications is promising but not yet confirmed. Confidence here is low to moderate. The finding that three or more surgeries carries higher risk also needs confirmation, but it is consistent with what clinicians would expect from repeated operations.
Any nutrition changes should be planned with the child’s medical and nutrition team rather than made independently.
Families of children with early-onset scoliosis who are receiving or planning growing-rod treatment, along with orthopedic surgeons, pediatric nutrition specialists, and care coordinators, should pay attention to these findings.
Adults with scoliosis who had surgery as adults, people without spinal conditions, and anyone looking for general weight-loss or diet advice will find little direct application here.
Nutrition improvements typically take weeks to months to show measurable changes in body weight and muscle strength, and the body’s healing after surgery varies from child to child. Because growing-rod treatment can span several years with repeated procedures, nutrition checks are most useful when they are ongoing rather than one-time. Benefits from timely support would be expected to build over the full treatment course rather than appear right away.
Frequently Asked Questions
Does poor nutrition increase the risk of problems after growing-rod surgery for scoliosis?
Research reviewed by Gram found a higher complication rate in malnourished children, at 23.9% compared with 7.5% in well-nourished children. The link was not statistically strong after a stricter test, so larger studies are needed to confirm it.
How does scoliosis affect the way doctors measure a child’s nutrition?
Spinal curves reduce measured standing height, which can distort body mass index and misclassify nutrition. Researchers corrected height using the Ylikoski formula before each procedure, which gave a more accurate picture of each child’s nutritional status.
Are repeated growing-rod surgeries riskier for children with scoliosis?
A study of 53 patients found that having three or more growing-rod surgeries was associated with about 4.6 times the odds of complications. This suggests repeated procedures may add cumulative risk, though more research is needed to confirm the pattern.
How often should a child with early-onset scoliosis have nutrition checked before surgery?
The study checked nutrition before every growing-rod procedure, which the authors suggest is a useful approach. Families should ask their surgical and nutrition teams for a schedule that fits the child’s treatment plan and growth.
Want to Apply This Research?
- Record the child’s weight and a height estimate before each scheduled procedure or checkup, and note the date of each surgery in order. Track how many procedures the child has had so far, since this study linked three or more surgeries to higher risk.
- Use the app to set reminders for pre-surgery nutrition checks and to log meals, protein intake, and any appetite or eating problems. Share these logs with the care team before each procedure so that nutrition concerns can be addressed early.
- Maintain a long-term log that connects each procedure with nutrition readings, weight trends, complications, and recovery notes. Review the trends with the care team at regular intervals to spot patterns early, and update the log whenever height estimates change as the child grows.
This article summarizes a single retrospective study and is for general education only. It is not medical advice. Nutrition and surgical decisions for children with scoliosis should be made with a qualified pediatric orthopedic surgeon, pediatric dietitian, or other licensed healthcare provider who knows the child’s full medical history.
This research translation is published by Gram Research, the science division of Gram, an AI-powered nutrition tracking app.