Spine Trauma Resource Priorities in Sub-Saharan Africa: A Delphi Approach

TL;DR

This study identifies the most important resources needed for spine trauma care in sub-Saharan Africa using expert opinions.

Contribution

The study uses a Delphi approach to prioritize spine trauma resources specific to sub-Saharan Africa.

Findings

Braces/c-collars, spine training, and access to implants were top priorities.

Microscopes, endoscopes, and navigation tools did not reach consensus as essential.

Efforts should focus on timely stabilization resources rather than advanced technologies.

Abstract

Delphi study.

Optimal spine trauma care requires extensive resource availability and training. In LMICs, where resources and training are scarcer, spine trauma represents a major source of disability and public health burden. This study aimed to evaluate the highest priority resource needs for spine surgeons in sub-Saharan Africa in order to provide safe, high-quality spine trauma care.

This study utilized a Delphi methodology with three electronic surveys. Participants were identified through the Continental Association of African Neurosurgical Societies (CAANS) and College of Surgeons of East, Central, and Southern Africa (COSECSA) networks. Response collection lasted from August 2024 to May 2025. The initial survey was an open-ended collection of all spine trauma resource priorities. In each subsequent round, participants rated topics on a Likert scale from 1 (most important) to 9 (least important). Consensus was defined as topics ranked 1, 2 or 3 (highly important) by >70% of participants.

Invitations were sent to 75 potential participants, with 36 participating in round one. Thirty-four participants (94.4%) and thirty-five (97.2%) completed the second and third consensus rounds respectively. Fifty-one items reached consensus. The most highly rated items included braces/c-collars, spine training/education of emergency room physicians and surgeons, and access to implants. Items not reaching consensus included microscopes, endoscopes, navigation and specialized auxiliary personnel.

Given the high burden of traumatic spine injury and resource needs in these regions, efforts should be focused on providing essential resources related to timely stabilization of the spine over advanced tools and technologies.

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