How Often do you Lengthen

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Presentation transcript:

How Often do you Lengthen How Often do you Lengthen?: A Physician Survey on Lengthening Practice for VEPTR

Introduction VEPTR treatment for early onset scoliosis (EOS) involves complex treatment decisions because of the complicated patient population Lengthening interval is a crucial component of treatment

Introduction With complicated patients, multiple factors can potentially contribute to decisions regarding lengthening interval: Time From last expansion Patient skeletal maturity Patient age Underlying diagnosis Levels spanned by VEPTR Previous resistance during lengthening Patient support network Duration of Implant Magnitude of deformity Time of year Etc.

Purpose The purpose of this project was to survey VEPTR surgeons for which factors they use in determining when to proceed with a lengthening procedure

Methods 37 surgeons who perform VETPR surgery from the Children’s Spine Study Group were anonymously surveyed about the factors they consider in VEPTR expansion

Results Time elapsed from the last expansion was identified as the most important factor: 94% of responders agreed that time was the most important factor in decision making 100% frequently (>25% of cases) use time elapsed from last expansion 97.3% reported to frequently use a standard time interval A 6 month time interval was most commonly reported with 78.4% of responders agreeing.

Results – Factors Commonly Used In addition to time, several other factors were found to be used frequently (>25%) by surgeons 73% claim to use patient maturity 73% reported frequently utilizing patient age 51.4% reported using underlying diagnosis frequently

Results – Factors NOT commonly Used Survey identified several factors which were infrequently (less than 25% of cases) utilized by surgeons when to proceed with a lengthening. 75.7% of surgeons reported using bone quality infrequently 73% reported using the # of spinal levels spanned by VEPTR to plan a lengthening infrequently 73% used time of year infrequently when planning an expansion 70.3% used the resistance encountered in the most recent lengthening infrequently when planning future expansions

Discussion Despite the lack of evidence based guidelines for VEPTR expansion planning, there exist trends in lengthening practice. There is relative consensus on both frequently and infrequently used factors for deciding when to proceed with a lengthening. These consensus data help to identify areas amenable to future research and the development of evidence based guidelines