Delphi consensus studies [Neurosurgery Wiki]

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===== Delphi consensus studies =====

The de novo non-specific [[spinal infection management]]s ([[spondylodiscitis]] - SD) remains inconsistent due to varying clinical practices and a lack of high-level [[evidence]], particularly regarding the indications for surgery.

[[Research question]]: This study aimed to develop [[consensus]] [[recommendation]]s for [[spondylodiscitis diagnosis]] and [[spondylodiscitis management]], addressing diagnostic modalities, surgical indications, and [[spondylodiscitis treatment]] strategies.

A [[Delphi]] process was conducted with 26 [[expert]]s from the [[European Association of Neurosurgical Societies]] ([[EANS]]). Sixtytwo statements were developed on diagnostic workup, management decisions, surgical techniques, non-surgical treatment, and follow-up and submitted to the panel of experts.

Consensus was reached on 38 of 62 statements. [[MRI]] was confirmed as the gold standard for diagnosis. Regarding surgical indications, the panel agreed that any new neurological deficit, even subtle, warrants surgical consideration. [[Motor deficit]]s with a motor score (MRC) below 4 and [[bladder]] or [[bowel]] [[dysfunction]] were unanimously considered clear indications for surgery. For [[spinal deformity]] and [[instability]], thresholds such as [[kyphosis]] >20°, [[scoliosis]] >10°, and vertebral body [[collapse]] >50% were established to guide surgical [[decision-making]]. [[Minimally invasive surgery]] (MIS) was endorsed whenever feasible, and a 12 week [[antibiotic]] treatment regimen was favored in cases of complicated infections.

This EANS consensus provides updated [[recommendation]]s for [[spondylodiscitis management]], incorporating recent [[evidence]] on improved outcomes with surgical therapy. While these [[guideline]]s offer a more structured approach to clinical decision-making, further research is required to optimize surgical timing and validate the long-term impact of these treatment strategies
((Kramer A, Thavarajasingam SG, Neuhoff J, Davies B, Barbagallo G, Debono B, Depreitere B, Eicker SO, Gabrovsky N, Gandia-Gonzalez ML, Ivanov M, Kaiser R, Kaprovoy S, Konovalov N, Lafuente J, Maciejczak A, Meyer B, Pereira P, Petrova Y, Peul WC, Reizinho C, Ryang YM, Sampron N, Schär R, Tessitore E, Thomé C, Timothy J, Vleggeert-Lankamp C, Demetriades AK, Shiban E, Ringel F. Diagnosis and management of de novo non-specific [[spinal infection]]s: European Association of Neurosurgical Societies (EANS) Spine Section Delphi consensus recommendations. Brain Spine. 2024 Dec 31;5:104178. doi: 10.1016/j.bas.2024.104178. PMID: 39866360; PMCID: PMC11763570.)).