SPINE20 recommendations 2022: spine care—working together to recover stronger
Authors: Darwono Bambang , Tamai Koji , Côté Pierre , Aleissa Sami , Rahim Agus Hadian , Pereira Paulo , Alsobayel Hana , Chhabra Harvinder S. , Costanzo Giuseppe , Ito Manabu , Kandziora Frank , Lahey Donna , Menezes Cristiano M. , Bajammal Sohail , Sullivan William J. , Vajkoczy Peter , Ahmad Alaa , Arand Markus , Asmiragani Saiful , Blattert Thomas R. , Busari Jamiu , Dohring Edward J. , Misaggi Bernardo , Muehlbauer Eric J. , Mulukutla Raghava D. , Munting Everard , Piccirillo Michael , Ruosi Carlo , Alturkistany Ahmed , Campello Marco , Hsieh Patrick C. , Teli Marco G. A. , Wang Jeffrey C. , Nordin Margareta 
Published: November 2022

Abstract
Purpose
Globally, spine disorders are the leading cause of disability, affecting more than half a billion individuals. However, less than 50% of G20 countries specifically identify spine health within their public policy priorities. Therefore, it is crucial to raise awareness among policy makers of the disabling effect of spine disorders and their impact on the economic welfare of G20 nations. In 2019, SPINE20 was established as the leading advocacy group to bring global attention to spine disorders.

Methods
Recommendations were developed through two Delphi methods with international and multi-professional panels.

Results
In 2022, seven recommendations were delivered to the leaders of G20 countries, urging them to: Develop action plans to provide universal access to evidence-based spine care that incorporates the needs of minorities and vulnerable populations. Invest in the development of sustainable human resource capacity, through multisectoral and inter-professional competency-based education and training to promote evidence-based approaches to spine care, and to build an appropriate healthcare working environment that optimizes the delivery of safe health services. Develop policies using the best available evidence to properly manage spine disorders and to prolong functional healthy life expectancy in the era of an aging population. Create a competent workforce and improve the healthcare infrastructure/facilities including equipment to provide evidence-based inter-professional rehabilitation services to patients with spinal cord injury throughout their continuum of care. Build collaborative and innovative translational research capacity within national, regional, and global healthcare systems for state-of-the-art and cost-effective spine care across the healthcare continuum ensuring equality, diversity, and inclusion of all stakeholders. Develop international consensus statements on patient outcomes and how they can be used to define and develop pathways for value-based care. Recognize that intervening on determinants of health including physical activity, nutrition, physical and psychosocial workplace environment, and smoking-free lifestyle can reduce the burden of spine disabilities and improve the health status and wellness of the population.
At the third SPINE20 summit 2022 which took place in Bali, Indonesia, in August 2022, 17 associations endorsed its recommendations.

Conclusion
SPINE20 advocacy efforts focus on developing public policy recommendations to improve the health, welfare, and wellness of all who suffer from spinal pain and disability. We propose that focusing on facilitating access to systems that prioritize value-based care delivered by a competent healthcare workforce will reduce disability and improve the productivity of the G20 nations.