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Title: How Often Do You Lengthen? A Physician Survey on Lengthening Practice for Prosthetic Rib Devices

Authors: Striano BM, Refakis C, Garg S, El-Hawary R, Pahys JM, Vitale MG, Campbell RM, Flynn JM, Cahill PJ

Journal: Spine Deformity

Date: July 01, 2018

Excerpt: In order to identify current trends in practice and inform clinicians of the practice patterns of peers with a special interest and high volumes in VEPTR surgery, surgeons with considerable experience using VEPTR devices were surveyed about their personal practice and thought process for determining lengthening intervals.

Keywords: VEPTR; Physician Survey; EOS; Surgery



What is the purpose of this study?

This study included a survey that was sent to Children Spine Study Group Surgeon members who had experience using growth friendly devices that are implanted on the rib. The purpose of this survey was to identify surgeon patterns when using these devices.


  • Of 47 surgeons that received the survey, 37 surgeons anonymously completed it.
  • The surgeons showed 94.6% agreement that timing is the most important factor for VEPTR expansions. 26 surgeons expressed that a standard timeframe should be used with 29 surgeons using a six-month interval for VEPTR expansions.
  • The surgeons varied greatly in other factors used to guide future expansions. 26 used the last procedure as a guide for future procedures. Individualized patient care appeared to drive different care tactics.
  • Patient and family also showed an effect on expansion planning. Things like social involvement, school activities, sports schedules and work all were indicated as influencers.
  • Utilization of the implant and other expansion considerations were not found to have a consensus as patient diagnosis and surgeon preference appeared to impact care decisions.

Important Discussion Points

  • Most surgeons expand twice yearly. This follows prior research into optimization of expansion intervals. Lengthening too frequently has been shown to produce increased complications.
  • This study provides the basis for best practice guidelines for both low and high-volume centers.  It may also be helpful for third-party payors and to guide the use of newer technology.