Consensus-Based Best Practice Guidelines for the Management of Spinal Deformity and Associated Tumors in Pediatric Neurofibromatosis Type 1: Screening and Surveillance, Surgical Intervention, and Medical Therapy.

Spinal conditions, such as scoliosis and spinal tumors, are prevalent in neurofibromatosis type 1 (NF1). Despite the recognized importance of their early detection and treatment, there remain knowledge gaps in how to approach these manifestations. The purpose of this study was to utilize the experience of a multidisciplinary committee of experts to establish consensus-based best practice guidelines (BPGs) for spinal screening and surveillance, surgical intervention, and medical therapy in pediatric patients with NF1. Using the results of a prior systematic review, 10 key questions that required further assessment were first identified. A committee of 20 experts across medical specialties was then chosen based on their clinical experience with spinal deformity and tumors in NF1. These were 9 orthopaedic surgeons, 4 neuro-oncologists/oncologists, 3 neurosurgeons, 2 neurologists, 1 pulmonologist, and 1 clinical geneticist. An initial online survey on current practices and opinions was conducted, followed by 2 additional surveys via a formal consensus-based modified Delphi method. The final survey involved voting on agreement or disagreement with 35 recommendations. Items reaching consensus (≥70% agreement or disagreement) were included in the final BPGs. Consensus was reached for 30 total recommendations on the management of spinal deformity and tumors in NF1. These were 11 recommendations on screening and surveillance, 16 on surgical intervention, and 3 on medical therapy. Five recommendations did not achieve consensus and were excluded from the BPGs. We present a set of consensus-based BPGs comprised of 30 recommendations for spinal screening and surveillance, surgical intervention, and medical therapy in pediatric NF1.

Xu AL ，Suresh KV ，Gomez JA ，Emans JB ，Larson AN ，Cahill PJ ，Andras LM ，White KK ，Miller DJ ，Murphy JS ，Groves ML ，Belzberg AJ ，Hwang SW ，Rosser TL ，Staedtke V ，Ullrich NJ ，Sato AA ，Blakeley JO ，Schorry EK ，Gross AM ，Redding GJ ，Sponseller PD ，Pediatric Spine Study Group ... -  《-》

Building Consensus: Development of Best Practice Guidelines on Wrong Level Surgery in Spinal Deformity.

Consensus-building using the Delphi and nominal group technique. To establish best practice guidelines using formal techniques of consensus building among a group of experienced spinal deformity surgeons to avert wrong-level spinal deformity surgery. Numerous previous studies have demonstrated that wrong-level spinal deformity occurs at a substantial rate, with more than half of all spine surgeons reporting direct or indirect experience operating on the wrong levels. Nevertheless, currently, guidelines to avert wrong-level spinal deformity surgery have not been developed. The Delphi process and nominal group technique were used to formally derive consensus among 16 fellowship-trained spine surgeons. Surgeons were surveyed for current practices, presented with the results of a systematic review, and asked to vote anonymously for or against item inclusion during three iterative rounds. Agreement of 80% or higher was considered consensus. Items near consensus (70% to 80% agreement) were probed in detail using the nominal group technique in a facilitated group meeting. Participants had a mean of 13.4 years of practice (range: 2-32 years) and 103.1 (range: 50-250) annual spinal deformity surgeries, with a combined total of 24,200 procedures. Consensus was reached for the creation of best practice guidelines (BPGs) consisting of 17 interventions to avert wrong-level surgery. A final checklist consisting of preoperative and intraoperative methods, including standardized vertebral-level counting and optimal imaging criteria, was supported by 100% of participants. We developed consensus-based best practice guidelines for the prevention of wrong-vertebral-level surgery. This can serve as a tool to reduce the variability in preoperative and intraoperative practices and guide research regarding the effectiveness of such interventions on the incidence of wrong-level surgery. Level V.

Vitale M ，Minkara A ，Matsumoto H ，Albert T ，Anderson R ，Angevine P ，Buckland A ，Cho S ，Cunningham M ，Errico T ，Fischer C ，Kim HJ ，Lehman R Jr ，Lonner B ，Passias P ，Protopsaltis T ，Schwab F ，Lenke L ... -  《-》

Best Practice Guidelines for Surgical Site Infection in High-risk Pediatric Spine Surgery: Definition, Prevention, Diagnosis, and Treatment.

Prior "best practice guidelines" (BPG) have identified strategies to reduce the risk of acute deep surgical site infection (SSI), but there still exists large variability in practice. Further, there is still no consensus on which patients are "high risk" for SSI and how SSI should be diagnosed or treated in pediatric spine surgery. We sought to develop an updated, consensus-based BPG informed by available literature and expert opinion on defining high-SSI risk in pediatric spine surgery and on prevention, diagnosis, and treatment of SSI in this high-risk population. After a systematic review of the literature, an expert panel of 21 pediatric spine surgeons was selected from the Harms Study Group based on extensive experience in the field of pediatric spine surgery. Using the Delphi process and iterative survey rounds, the expert panel was surveyed for current practices, presented with the systematic review, given the opportunity to voice opinions through a live discussion session and asked to vote regarding preferences privately. Two survey rounds were conducted electronically, after which a live conference was held to present and discuss results. A final electronic survey was then conducted for final voting. Agreement ≥70% was considered consensus. Items near consensus were revised if feasible to achieve consensus in subsequent surveys. Consensus was reached for 17 items for defining high-SSI risk, 17 items for preventing, 6 for diagnosing, and 9 for treating SSI in this high-risk population. After final voting, all 21 experts agreed to the publication and implementation of these items in their practice. We present a set of updated consensus-based BPGs for defining high-risk and preventing, diagnosing, and treating SSI in high-risk pediatric spine surgery. We believe that this BPG can limit variability in practice and decrease the incidence of SSI in pediatric spine surgery. Not applicable.

Badin D ，Leland CR ，Matsumoto H ，Roye B ，Vitale M ，Flynn J ，Samdani A ，Larson AN ，Yaszay B ，Pahys J ，Glotzbecker M ，Bachmann KR ，Newton PO ，Betz R ，Miyanji F ，Shah S ，Sturm PF ，Hwang S ，Erickson M ，Cahill PJ ，Fletcher N ，Upasani VV ，Sucato DJ ，Sponseller PD ... -  《-》

Establishing Consensus on the Best Practice Guidelines for Use of Halo Gravity Traction for Pediatric Spinal Deformity.

Roye BD ，Campbell ML ，Matsumoto H ，Pahys JM ，Welborn MC ，Sawyer J ，Fletcher ND ，McIntosh AL ，Sturm PF ，Gomez JA ，Roye DP ，Lenke LG ，Vitale MG ，Children’s Spine Study Group ... -  《-》

Building consensus: development of a Best Practice Guideline (BPG) for surgical site infection (SSI) prevention in high-risk pediatric spine surgery.

Vitale MG ，Riedel MD ，Glotzbecker MP ，Matsumoto H ，Roye DP ，Akbarnia BA ，Anderson RC ，Brockmeyer DL ，Emans JB ，Erickson M ，Flynn JM ，Lenke LG ，Lewis SJ ，Luhmann SJ ，McLeod LM ，Newton PO ，Nyquist AC ，Richards BS 3rd ，Shah SA ，Skaggs DL ，Smith JT ，Sponseller PD ，Sucato DJ ，Zeller RD ，Saiman L ... -  《-》