The Generational Differences in Growth-Friendly Treatment Utilization for Early-Onset Scoliosis

Abstract

Background: The development of new growth-friendly techniques for treating early-onset scoliosis (EOS) has resulted in a rapidly changing landscape of available treatment strategies. There is no literature revealing how a surgeon's years in practice (YIP) is related to the EOS techniques they learned in fellowship and how their YIP influences their decision-making in selecting EOS constructs. The purpose of this study was to assess how a surgeon's fellowship training and their years in practice (YIP) might affect which treatments they use in practice as well as attempt to gain insight into their decision-making process for such treatments.Methods: A 25-question survey was electronically delivered to 144 surgeons who treat EOS, and 87 (60%) responded. Surgeons were divided into two groups: a younger group (YG) with 0-10 YIP and an older group (OG) with >10 YIP. Growth-friendly techniques queried included serial casting, traditional growing rods (TGR), Vertical Expandable Prosthetic Titanium Rib (VEPTR), non-VEPTR rib constructs, Magnetically Controlled Growing Rods (MCGR), and Shilla. A Chi-square analysis was used to determine differences between the YIP groups with regard to which techniques surgeons learned in fellowship and which techniques they use in practice.Results: One hundred percent (38/38) of the YG surgeons were fellowship-trained versus 87.8% (43/49) of the OG surgeons. More YG versus OG surgeons received fellowship training in serial casting (84.2% vs. 38.8%, p<0.001), TGR (94.7% vs. 63.3%, p<0.001), VEPTR (65.8% vs. 28.6, p<0.001), non-VEPTR rib constructs (55.3% vs. 16.3%, p<0.001), and MCGR (47.4% vs. 2%, p<0.001). OG surgeons were more likely to use TGR in the last 3 years, with 26% of YG versus 6% of OG surgeons never utilizing TGR and 5% of YG versus 31% of OG surgeons performing TGR cases > 10 times (p=.004). Regarding treatment preferences, more YG surgeons (84.2% vs. 39.6%, p<0.001) preferred to delay intervention until final fusion rather than use any growth-friendly techniques. Furthermore, YG surgeons see a limited need for growth-friendly constructs other than MCGR.Conclusions: YG surgeons were more likely to learn growth-friendly techniques in fellowship than OG surgeons, though in their practices, the groups use growth-friendly techniques at similar rates. Compared to OG surgeons, YG surgeons prefer performing definitive fusions over utilizing any growth-friendly surgical techniques.Key Concepts•The landscape of treatment options for early-onset scoliosis has changed significantly over the past few decades.•Aside from younger surgeons' proclivity to use magnetically controlled growing rods at higher rates than older surgeons, the two groups reported using other growth-friendly treatments at similar frequencies.•Younger surgeons were more likely than older surgeons to prefer waiting to perform a single definitive fusion rather than using a growth-friendly technique to treat early-onset scoliosis.