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

2. 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

3. 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.

4. 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

5. 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

6. 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.

7. 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

8. 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

9. 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