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

STUDY DESIGN: Physician survey.

OBJECTIVES: To identify physician practice patterns in use of prosthetic rib devices.

BACKGROUND: Management of scoliosis with prosthetic ribs involves repeated expansions. Despite this, there is a paucity of literature on expansion practice. We believe that despite minimal literature, there exist surgeon practice patterns.

METHODS: Thirty-seven surgeons from the Children's Spine Study Group, with prosthetic rib experience, were anonymously surveyed about their expansion practice.

RESULTS: There was strong consensus that elapsed time since previous surgery was the most important factor in choosing lengthening intervals, with 94.5% of responders agreeing. Surgeons indicated that they often apply a standard expansion interval. 97.3% reported using one in >25% of cases, with 70.3% using a standard interval in >80% of cases. Six months was the most commonly reported elapsed time interval, with 78.4% of responders in agreement. There was also consensus on non-time factors. Patient maturity was cited a major factor in choosing lengthening interval in >80% of cases by 59.5% of responders. Patient age was frequently cited as a factor, with 73% of surgeons using it in >25% of cases. Additionally, there was consensus on factors that were not utilized. More than three-fourths (75.7%) stated that they use patients' bone quality <25% of the time. Similarly, 70.3% used resistance encountered in the last lengthening <25% of the time, with 13.5% never considering.

CONCLUSION: Despite the lack of evidence-based guidelines regarding lengthening practice for prosthetic ribs, there is some consensus on the factors used to choose an appropriate expansion interval. The greatest consensus surrounded the use of a standard six-month elapsed time interval between expansions. From these data, we conclude that specialists have reached relative consensus on factors important for choosing an appropriate expansion interval. We believe these data are an important step toward developing best practice guidelines and identifying areas of equipoise amenable for future research.

LEVEL OF EVIDENCE: Level V.