• Federico Landriel, Kevin White, Fernando Padilla Lichtenberger, Alfredo Guiroy, Alisson Teles, Laos PlasierEduardoEDepartment of Neurosurgery, Almenara Hospital, Lima, Peru., Buzetti MilanoJerônimoJNeurosurgical Department, Neurological Institute of Curitiba, Brazil., Marcelo Risso, Nelson Astur, Oscar González, Ratko Yurac, Rodolfo Páez, William Teixeira, Maximiliano Toscano, and Santiago Hem.
• Neurosurgical Department, Spine Unit, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina. Electronic address: federico.landriel@hospitalitaliano.org.ar.
• World Neurosurg. 2025 Jan 13; 195: 123575123575.

BackgroundCombining surgery and radiotherapy is the gold standard in treating spinal metastasis when spinal stabilization or surgical decompression is required. Determining the optimal timing for radiotherapy postsurgery is crucial to balance treatment efficacy minimizing wound complications. The study aimed to identify consensus and nonconsensus areas among Latin American spinal surgeons regarding the use, timing, risks, and surgical approach to conventional external beam radiotherapy (cEBRT) following spinal surgery for metastases, specifically focusing on the risk of radiotherapy-related wound complications.MethodsA modified Delphi survey was conducted. The expert panel included active members of AOSpine Latin America with extensive experience in vertebral metastasis surgery. The surveys include 37 statements covering areas of interest. Inter-expert consensus was considered weak (70-79.9%), moderate (80-89.9%), and strong (≥90%).ResultsAt least 70% consensus was reached on 32 of the 37 statements (86.5%). This included strong consensus on 10 statements, moderate on 13, and weaker on nine. There was high consensus on sutures and lower consensus on risk factors for cEBRT delay. Experts reached strong agreement on the importance of poor nutrition as a risk factor for cEBRT-related wound complications. Perception of wound risk was greater with a posterior midline approach compared to other approaches, and the highest perceived complication risks were for junctional locations and sacral spine.ConclusionsWe report strong agreements among the experts on important issues such as waiting times and risk factors for cEBRT. The findings underscore the significance of considering factors such as, spinal levels, surgical approaches, and sutures when making clinical decisions.Copyright © 2024 The Authors. Published by Elsevier Inc. All rights reserved.

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