Developing consensus for the management of pediatric cervical spine disorders and stabilization: a modified Delphi...

Area of Science:

• Pediatric Orthopedics
• Pediatric Neurosurgery
• Spine Surgery

Background:

• Cervical spine disorders in children are uncommon, leading to a lack of established clinical management paradigms.
• This study aimed to develop consensus on the management of pediatric cervical spine disorders and stabilization surgery.

Approach:

• A modified Delphi approach was employed, involving an international, multidisciplinary group of pediatric spine experts.
• A survey of current practices and a literature review informed the development of consensus statements, refined through in-person meetings.

Key Points:

• Forty-five consensus statements were established, covering preoperative planning, radiographic instability thresholds, intraoperative/perioperative care, postoperative management, and nonoperative strategies.
• Key recommendations include using intraoperative neuromonitoring, rigid instrumentation, rigid cervical collars for 6-12 weeks postoperatively, and extended follow-up.
• Consensus on radiographic instability included specific thresholds for translational motion and dynamic angulation, along with MRI findings.

Conclusions:

• An international expert panel achieved consensus on 45 critical statements for managing pediatric cervical spine disorders and stabilization.
• Further research is needed to validate if implementing these consensus-based practices improves patient outcomes and reduces complications.