For ambulatory children with cerebral palsy, finding the right treatment option can be confusing. Dozens of surgeries exist that can potentially improve their gait. However, there’s little agreement over the indications for these procedures. As a result, many patients may not experience the best outcomes possible.

In 2020, Cincinnati Children’s began spearheading an effort that pointed orthopaedic surgeons in the right direction. Using feedback from an international group of experts in the field, the team compiled a list of recommended indications and contraindications for the procedures that are most often performed with this patient group. The team gathered input using the modified Delphi method, a process that typically collects anonymous responses from a group through several rounds of questionnaires.

“There’s not much literature in this field to make these kinds of recommendations, and getting it will take decades,” says James McCarthy, MD, director of the division of pediatric orthopaedics, noting there are millions of possible surgical procedure combinations. “Our goal was to gather expert knowledge, identify any alignment in treatment recommendations, and make that guidance available to others.”

Reaching Agreement

To create this guidance document, McCarthy’s team requested clinical input from 16 global experts who had more than 300 years of experience with cerebral palsy and motion analysis. Through several consensus rounds, they agreed upon the most common bony and soft tissue procedures.

According to McCarthy, experts in the group either came to a consensus or general agreement on the indications and contraindications of more than 250 areas for surgical indications for children with cerebral palsy.

Sharing the Knowledge

This list of recommendations can help surgeons with clinical decision-making, especially those who may be less familiar with these procedures, McCarthy says.

“If someone has only been doing these procedures for a few years, identifying the right procedure combination is a concern. How can these surgeons get up to speed in this incredibly complex world—especially if they don’t live and breathe these procedures every day?” he says. “If we can give them a game plan or outline things to consider or not to do, that will make it easier.”

To date, the team has made their findings available through six publications in open-access journals. They have also presented their results in a variety of symposiums and workshops. The next step will be evidence-based research.

Ultimately, McCarthy says, the goal is to expand the knowledge base for surgeons to decrease harm and to improve patient outcomes.

“With this list, surgeons are poised to choose a surgical option that can be done with the least amount of pain or discomfort,” he says, “if they can choose something that presents the least risk and provide the best outcomes.”