Related Experiment Video
Updated: Nov 10, 2025
Minimally Invasive Treatment for Thoracolumbar Burst Fracture Using Sagittal Alignment Screws and A Trauma Reduction Device
Published on: November 8, 2024
Development of best practices in the utilization and implementation of pediatric cervical spine traction: a modified
Nikita G Alexiades1, Belinda Shao1,2, Bruno P Braga3
11Department of Neurological Surgery, Columbia University Medical Center, New York, New York.
Insights
Pediatric cervical traction best practices were established using a Delphi method. This consensus aims to improve the safety and effectiveness of cervical traction for children with spinal trauma or deformities.
Area of Science:
- Pediatric Neurosurgery
- Orthopedic Surgery
- Spinal Trauma Management
Background:
- Cervical traction is crucial for pediatric cervical trauma and deformity but lacks empirical evidence.
- Current practices often rely on modified adult protocols, highlighting a need for standardized pediatric guidelines.
Purpose of the Study:
- To establish expert consensus on best practices for pediatric cervical traction.
- To enhance the utilization, safety, and efficacy of this treatment in children.
Main Methods:
- A modified Delphi method was used with 20 pediatric neurosurgery and orthopedic surgery experts.
- Surveys and an in-person meeting were conducted to achieve consensus (≥80% agreement).
Main Results:
- Consensus was reached on 49 best-practice recommendations across 5 key areas.
- These areas include goals, indications, contraindications, imaging, application, trauma/deformity protocols, and complication management.
Conclusions:
- 49 best-practice recommendations for pediatric cervical traction were identified through expert consensus.
- Further research is needed to validate the impact of these practices on patient outcomes and complication rates.
Objective:
Cervical traction in pediatric patients is an uncommon but invaluable technique in the management of cervical trauma and deformity. Despite its utility, little empirical evidence exists to guide its implementation, with most practitioners employing custom or modified adult protocols. Expert-based best practices may improve the care of children undergoing cervical traction. In this study, the authors aimed to build consensus and establish best practices for the use of pediatric cervical traction in order to enhance its utilization, safety, and efficacy.
Methods:
A modified Delphi method was employed to try to identify areas of consensus regarding the utilization and implementation of pediatric cervical spine traction. A literature review of pediatric cervical traction was distributed electronically along with a survey of current practices to a group of 20 board-certified pediatric neurosurgeons and orthopedic surgeons with expertise in the pediatric cervical spine. Sixty statements were then formulated and distributed to the group. The results of the second survey were discussed during an in-person meeting leading to further consensus. Consensus was defined as ≥ 80% agreement on a 4-point Likert scale (strongly agree, agree, disagree, strongly disagree).
Results:
After the initial round, consensus was achieved with 40 statements regarding the following topics: goals, indications, and contraindications of traction (12), pretraction imaging (6), practical application and initiation of various traction techniques (8), protocols in trauma and deformity patients (8), and management of traction-related complications (6). Following the second round, an additional 9 statements reached consensus related to goals/indications/contraindications of traction (4), related to initiation of traction (4), and related to complication management (1). All participants were willing to incorporate the consensus statements into their practice.
Conclusions:
In an attempt to improve and standardize the use of cervical traction in pediatric patients, the authors have identified 49 best-practice recommendations, which were generated by reaching consensus among a multidisciplinary group of pediatric spine experts using a modified Delphi technique. Further study is required to determine if implementation of these practices can lead to reduced complications and improved outcomes for children.
