Foreword

Asociación Mexicana de Cirujanos de Columna, A.C. (AMCICO)

As President of the Asociación Mexicana de Cirujanos de Columna, A.C. (AMCICO), I am honored to endorse Real World Evidence in Spine Surgery: 2026 Update. This publication represents an important contribution to contemporary spine surgery and offers a timely perspective on the role of endoscopic techniques in modern clinical care.

What distinguishes this volume is its effort to connect scientific evidence with the realities of day-to-day surgical practice. Through focused PICO-based chapters, updated literature reviews, and surgeon survey data analyzed using Rasch methodology, the editors provide a thoughtful and clinically grounded approach to understanding how evidence is interpreted and applied in the treatment of spinal disorders.

Particularly valuable is the book’s willingness to revisit accepted treatment pathways within a real-world context. Rather than assuming that current standards should remain unchanged, it considers whether ongoing technological advances and improved insight into disease mechanisms justify refinement of existing protocols.

From the perspective of AMCICO, this type of analysis is highly relevant. Progress in spine surgery depends not only on innovation itself, but also on careful evaluation of when new techniques should complement, modify, or replace established approaches. In that sense, this work supports more informed surgical judgment, more responsible adoption of emerging technologies, and a stronger commitment to patient-centered care.

The editors—Kai-Uwe Lewandrowski, Alexander Richard Vaccaro, Morgan P. Lorio, Paul Park, Rossano Kepler Alvim Fiorelli, and Benedikt W. Burkhardt—deserve recognition for preparing a scholarly and internationally relevant volume that promotes critical thinking and continued advancement in spine surgery.

Sincerely,

Asociacion Argentina de Cirugia Minimamente Invasiva de Columna (ARMISS)

As President of Asociación Argentina de Cirugía Minimamente Invasiva de Columna (ARMISS), I am proud to endorse Real World Evidence in Spine Surgery: 2026 Update, a book whose international perspective and methodological rigor are especially meaningful to spine surgeons working across diverse healthcare environments.

This international relevance is reinforced by the topics selected: perioperative risk, neuromonitoring, 3D-printed implants, robotics and navigation, tubular and endoscopic decompression, transforaminal techniques, and cervical endoscopic applications. These are precisely the areas where global adoption often outpaces guideline certainty, and where regional experience matters.

It speaks to surgeons who must adapt innovation thoughtfully rather than simply import it uncritically.

I am confident that this book will be especially valuable to the international spine community, including surgeons, trainees, researchers, and leaders working across diverse systems of care. I congratulate the editorial team on a text that is rigorous, current, and genuinely global in outlook.

The editors, Kai-Uwe Lewandrowski, Alexander Richard Vaccaro, Morgan P. Lorio, Paul Park, Rossano Kepler Alvim Fiorelli, and Benedikt W. Burkhardt, are to be congratulated for producing a volume that will support informed surgical judgment, critical appraisal of new technologies, and higher-quality patient care across the spine community.

Sincerely,

Brazilian Spine Society (SBC)

I am pleased, on behalf of the Brazilian Spine Society (SBC), to support Real World Evidence in Spine Surgery: 2026 Update. The volume stands out because it does not treat evidence as abstract; instead, it tests how well published conclusions align with the choices spine surgeons make in actual practice.

One of the volume's strongest features is its refusal to flatten complex questions into simple recommendations. Instead, it highlights discrepancy analysis, decision quality, and the practical meaning of evidence when treating real patients in real systems.

The result is a volume that is both academically serious and immediately readable for busy clinicians.

Because of that breadth and methodological seriousness, I believe the volume will have long-term value for both day-to-day practice and future academic discussion. I warmly commend the editorial team for this thoughtful contribution to the field.

The editors, Kai-Uwe Lewandrowski, Alexander Richard Vaccaro, Morgan P. Lorio, Paul Park, Rossano Kepler Alvim Fiorelli, and Benedikt W. Burkhardt, are to be congratulated for producing a volume that will support informed surgical judgment, critical appraisal of new technologies, and higher-quality patient care across the spine community.

Sincerely,

International Society for Minimal Intervention in Spinal Surgery (ISMISS)

As President of the International Society for Minimal Intervention in Spinal Surgery (ISMISS), I am honored to endorse Real World Evidence in Spine Surgery: 2026 Update, a substantial and timely contribution to the literature of contemporary spine care.

The chapter selection is broad without being diffuse. Topics such as wound drains in routine ACDF, obesity and perioperative risk, intraoperative neuromonitoring, 3D-printed implants, robotics and navigation, and both tubular and endoscopic decompression strategies make the book relevant across the full spectrum of modern spine surgery.

Its usefulness lies in helping readers interpret variation rather than pretending variation does not exist.

I expect this book to become a durable reference for surgeons, trainees, researchers, and society leaders who want a more complete understanding of what constitutes meaningful evidence in spine surgery. The editors and contributors are to be congratulated for an important and timely accomplishment.

The editors, Kai-Uwe Lewandrowski, Alexander Richard Vaccaro, Morgan P. Lorio, Paul Park, Rossano Kepler Alvim Fiorelli, and Benedikt W. Burkhardt, are to be congratulated for producing a volume that will support informed surgical judgment, critical appraisal of new technologies, and higher-quality patient care across the spine community.

Sincerely,

International Society of Endoscopic Spine Surgery (ISESS)

On behalf of the International Society of Endoscopic Spine Surgery (ISESS), I am pleased to express my support for Real World Evidence in Spine Surgery: 2026 Update. This volume is particularly important because it addresses spine surgery as it is actually practiced: a field shaped not only by formal evidence, but also by experience, evolving techniques, patient selection, and the realities of clinical decision-making.

What makes this work especially compelling is its balanced perspective. It does not treat innovation as inherently beneficial simply because it is new, nor does it dismiss progress because long-term data are still developing. Instead, it offers a thoughtful framework for assessing, refining, and integrating emerging approaches into patient care.

This perspective is highly relevant to endoscopic spine surgery, where rapid technical advancement must always be matched by careful evaluation, sound judgment, and attention to outcomes. The book reflects the understanding that meaningful progress in surgery depends not only on technological capability but also on appropriate indication, disciplined assessment, and continued learning from real-world clinical practice.

For these reasons, I believe this volume will serve not only as an important reference but also as a valuable contribution to the broader discussion of quality, innovation, and evidence in modern spine care. It is a timely and substantial work that will benefit surgeons, researchers, and the broader spine community.

The editors—Kai-Uwe Lewandrowski, Alexander Richard Vaccaro, Morgan P. Lorio, Paul Park, Rossano Kepler Alvim Fiorelli, and Benedikt W. Burkhardt—are to be congratulated for producing a volume that will strengthen informed surgical judgment, encourage critical appraisal of evolving technologies, and support higher-quality care for patients worldwide.

Sincerely,

Korean Minimally Invasive Spinal Surgery Society (KOMISS)

As President of the Korean Minimally Invasive Spinal Surgery Society (KOMISS), I am delighted to endorse Real World Evidence in Spine Surgery: 2026 Update, a forward-looking work that addresses one of the central questions in modern spine care: how to reconcile formal evidence hierarchies with the realities of minimally invasive surgical practice.

Across chapters on ACDF wound drains, obesity and perioperative risk, intraoperative neuromonitoring, robotics and navigation, and competing decompression strategies, the volume repeatedly asks the sec question: what happens when formal evidence is tested against routine surgical reality? That is precisely the question minimally invasive spine surgeons confront every day.

Its emphasis on discrepancy analysis is especially useful in procedures where published evidence and surgeon experience do not always align neatly.

I am confident that this book will serve as an important resource for surgeons, trainees, investigators, and professional societies seeking to define best practice in minimally invasive spine surgery. The editors are to be congratulated for a work of both intellectual rigor and practical value.

The editors, Kai-Uwe Lewandrowski, Alexander Richard Vaccaro, Morgan P. Lorio, Paul Park, Rossano Kepler Alvim Fiorelli, and Benedikt W. Burkhardt, are to be congratulated for producing a volume that will support informed surgical judgment, critical appraisal of new technologies, and higher-quality patient care across the spine community.

Sincerely,

Korean Research Society of Endoscopic Spine Surgery (KOSESS)

It is a privilege, in my capacity as President of the Korean Research Society of Endoscopic Spine Surgery (KOSESS), to endorse Real World Evidence in Spine Surgery: 2026 Update. The editors have assembled a work that moves beyond promotional narratives and instead examines how endoscopic techniques perform, evolve, and are adopted in the real world.

Its chapter architecture is particularly effective: focused PICO questions and updated literature reviews are paired with surgeon survey data analyzed through Rasch methodology, allowing the reader to see not only what the literature reports, but also how spine surgeons actually navigate decompression choices, endoscopic indications, and evolving cervical and lumbar techniques.

The text is especially persuasive in showing that endoscopic surgery should be assessed through longitudinal practice patterns, not only through isolated trial snapshots.

This volume deserves wide circulation among surgeons, educators, researchers, and decision-makers involved in the future of endoscopic spine surgery. I congratulate the editors on a book that is methodologically serious, clinically grounded, and internationally relevant.

The editors, Kai-Uwe Lewandrowski, Alexander Richard Vaccaro, Morgan P. Lorio, Paul Park, Rossano Kepler Alvim Fiorelli, and Benedikt W. Burkhardt, are to be congratulated for producing a volume that will support informed surgical judgment, critical appraisal of new technologies, and higher-quality patient care across the spine community.

Sincerely,

Korean Society for the Advancement of Spinal Surgery (KOSASS)

I am pleased, on behalf of the Korean Society for the Advancement of Spinal Surgery (KOSASS), to support Real World Evidence in Spine Surgery: 2026 Update. The volume stands out because it does not treat evidence as abstract; instead, it tests how well published conclusions align with the choices spine surgeons make in actual practice.

One of the volume's strongest features is its refusal to flatten complex questions into simple recommendations. Instead, it highlights discrepancy analysis, decision quality, and the practical meaning of evidence when treating real patients in real systems.

The result is a volume that is both academically serious and immediately readable for busy clinicians.

Because of that breadth and methodological seriousness, I believe the volume will have long-term value for both day-to-day practice and future academic discussion. I warmly commend the editorial team for this thoughtful contribution to the field.

The editors, Kai-Uwe Lewandrowski, Alexander Richard Vaccaro, Morgan P. Lorio, Paul Park, Rossano Kepler Alvim Fiorelli, and Benedikt W. Burkhardt, are to be congratulated for producing a volume that will support informed surgical judgment, critical appraisal of new technologies, and higher-quality patient care across the spine community.

Sincerely,

Korean Society for the Advancement of Spine Surgery (KOSASS)

I am pleased, on behalf of the Korean Society for the Advancement of Spinal Surgery (KOSASS), to support Real World Evidence in Spine Surgery: 2026 Update. The volume stands out because it does not treat evidence as abstract; instead, it tests how well published conclusions align with the choices spine surgeons make in actual practice.

One of the volume's strongest features is its refusal to flatten complex questions into simple recommendations. Instead, it highlights discrepancy analysis, decision quality, and the practical meaning of evidence when treating real patients in real systems.

The result is a volume that is both academically serious and immediately readable for busy clinicians.

Because of that breadth and methodological seriousness, I believe the volume will have long-term value for both day-to-day practice and future academic discussion. I warmly commend the editorial team for this thoughtful contribution to the field.

The editors, Kai-Uwe Lewandrowski, Alexander Richard Vaccaro, Morgan P. Lorio, Paul Park, Rossano Kepler Alvim Fiorelli, and Benedikt W. Burkhardt, are to be congratulated for producing a volume that will support informed surgical judgment, critical appraisal of new technologies, and higher-quality patient care across the spine community.

Sincerely,

Korean Society of Minimally Invasive Spine Surgery (K-MISS)

From the standpoint of the Korean Society of Minimally Invasive Spine Surgery (K-MISS), Real World Evidence in Spine Surgery: 2026 Update is an especially valuable contribution. It approaches contemporary spine surgery not as a static set of procedures, but as a rapidly changing field in which experience, patient selection, and implementation science matter alongside trial data.

This text is particularly persuasive because it avoids simplistic binaries. It recognizes that minimally invasive surgery advances through careful iteration, nuanced patient selection, and continuous comparison between what published studies recommend and what practicing surgeons actually encounter.

The volume recognizes that less invasive surgery is not defined by incision size alone, but by the quality of decision-making, the durability of the outcome, and the appropriateness of the indication.

For that reason, I believe the book will have enduring relevance not only as a reference text, but also as a framework for future discussion about quality, innovation, and value in spine surgery. I commend the editorial team for this substantial contribution.

The editors, Kai-Uwe Lewandrowski, Alexander Richard Vaccaro, Morgan P. Lorio, Paul Park, Rossano Kepler Alvim Fiorelli, and Benedikt W. Burkhardt, are to be congratulated for producing a volume that will support informed surgical judgment, critical appraisal of new technologies, and higher-quality patient care across the spine community.

Sincerely,

Minimally Invasive Spine Association of Bharat (MISSAB India)

From the standpoint of the Minimally Invasive Spine Association of Bharat (MISSAB India), Real World Evidence in Spine Surgery: 2026 Update is an especially valuable contribution. It approaches contemporary spine surgery not as a static set of procedures, but as a rapidly changing field in which experience, patient selection, and implementation science matter alongside trial data.

This text is particularly persuasive because it avoids simplistic binaries. It recognizes that minimally invasive surgery advances through careful iteration, nuanced patient selection, and continuous comparison between what published studies recommend and what practicing surgeons actually encounter.

The volume recognizes that less invasive surgery is not defined by incision size alone, but by the quality of decision-making, the durability of the outcome, and the appropriateness of the indication.

For that reason, I believe the book will have enduring relevance not only as a reference text, but also as a framework for future discussion about quality, innovation, and value in spine surgery. I commend the editorial team for this substantial contribution.

The editors, Kai-Uwe Lewandrowski, Alexander Richard Vaccaro, Morgan P. Lorio, Paul Park, Rossano Kepler Alvim Fiorelli, and Benedikt W. Burkhardt, are to be congratulated for producing a volume that will support informed surgical judgment, critical appraisal of new technologies, and higher-quality patient care across the spine community.

Sincerely,

MISABCON India

I am pleased to offer my endorsement of Real World Evidence in Spine Surgery: 2026 Update on behalf of MISABCON India. The book captures the practical intelligence of minimally invasive spine surgery while preserving a disciplined commitment to evidence-based analysis.

The book’s methodological design is one of its greatest strengths. By pairing PICO-driven reviews with surgeon survey data analyzed using Rasch methods, this approach creates a framework for understanding not only efficacy in the literature but also implementation, variation, and value in everyday clinical care.

It is rare to find a book that speaks equally well to experienced surgeons and to those helping define the next generation of minimally invasive standards.

This is the kind of book that helps a field mature. It offers guidance without oversimplification and innovation without hype. I am pleased to endorse it and expect it will be widely useful to the minimally invasive spine community.

The editors, Kai-Uwe Lewandrowski, Alexander Richard Vaccaro, Morgan P. Lorio, Paul Park, Rossano Kepler Alvim Fiorelli, and Benedikt W. Burkhardt, are to be congratulated for producing a volume that will support informed surgical judgment, critical appraisal of new technologies, and higher-quality patient care across the spine community.

Sincerely,

Sociedad Interamericana de Cirurgia de Columna Minimamente Invasiva (SICCMI)

As President of Sociedad Interamericana de Cirurgia de Columna Minimamente Invasiva (SICCMI), I am pleased to endorse Real World Evidence in Spine Surgery: 2026 Update, a comprehensive and highly relevant reference for orthopaedic spine surgeons who must evaluate both evidence quality and practical applicability.

For orthopaedic spine surgeons, this book is particularly useful because it speaks to the questions that most influence daily practice: implant strategy, obesity-related risk, neuromonitoring, navigation and robotics, decompression choice, and the interpretation of procedure-specific outcomes in the context of actual surgical workflows.

It offers the kind of structured reflection that is essential when evaluating procedure selection in contemporary orthopaedic spine practice.

I expect the book to be of lasting value to orthopaedic spine surgeons, neurosurgeons, trainees, clinical researchers, and professional societies interested in evidence translation and responsible adoption of new techniques. I gladly lend it my endorsement.

The editors, Kai-Uwe Lewandrowski, Alexander Richard Vaccaro, Morgan P. Lorio, Paul Park, Rossano Kepler Alvim Fiorelli, and Benedikt W. Burkhardtx, are to be congratulated for producing a volume that will support informed surgical judgment, critical appraisal of new technologies, and higher-quality patient care across the spine community.

Sincerely,

Singapore Spine Society (Endoscopic Focus Group)

On behalf of the Singapore Spine Society (Endoscopic Focus Group), it is our privilege to endorse Real World Evidence in Spine Surgery: 2026 Update. This volume represents a meaningful and methodologically robust contribution to the ongoing evolution of spine surgery, particularly in the domain of endoscopic techniques.

The editors have developed a work that goes beyond conventional summaries of the literature. Through a structured framework built on focused PICO questions, contemporary evidence synthesis, and surgeon-reported data analyzed using Rasch methodology, the text offers a balanced and practical perspective. It not only captures what is known from the literature but also reflects how spine surgeons are currently interpreting and applying these techniques in real-world settings.

A notable strength of this volume is its emphasis on longitudinal practice patterns. By examining how endoscopic approaches are adopted, refined, and integrated into clinical workflows, the book provides insights that extend beyond isolated clinical trials and more accurately represent everyday surgical decision-making.

This text will be of considerable value to surgeons, educators, researchers, and healthcare leaders seeking to critically evaluate emerging technologies and improve patient outcomes. Its international scope and analytical depth make it highly relevant to both regional and global spine communities.

We commend the editors—Kai-Uwe Lewandrowski, Alexander Richard Vaccaro, Morgan P. Lorio, Paul Park, Rossano Kepler Alvim Fiorelli, and Benedikt W. Burkhardt—for producing a volume that advances evidence-based practice, supports critical appraisal, and contributes to the continued progress of spine care.

Sincerely,

Sociedad de Neurocirugía de Chile

On behalf of the Sociedad de Neurocirugía de Chile, I am pleased to express my support for Real World Evidence in Spine Surgery: 2026 Update. This volume makes an important contribution by recognizing that contemporary spine surgery is shaped not only by published evidence, but also by clinical judgment, patient selection, evolving techniques, and the realities of everyday practice.

What gives this work particular value is its balanced and thoughtful perspective. It does not reduce progress to simple assumptions about innovation, nor does it frame surgical advancement in overly rigid terms. Instead, it presents spine care as a discipline that advances through careful evaluation, practical experience, and ongoing comparison between research findings and real-world outcomes.

The book is especially relevant because it acknowledges that quality in spine surgery is not defined solely by technical execution, but also by sound indication, durability of results, and responsible adoption of new methods. In that respect, it offers a meaningful framework for both present practice and future discussion.

For these reasons, I believe this volume will serve as more than a reference text. It will also contribute to broader conversations about quality, evidence, and innovation in spine surgery across the international neurosurgical community. The editorial team is to be commended for assembling such a timely and significant work.

The editors—Kai-Uwe Lewandrowski, Alexander Richard Vaccaro, Morgan P. Lorio, Paul Park, Rossano Kepler Alvim Fiorelli, and Benedikt W. Burkhardt—are to be congratulated for producing a volume that will support informed surgical decision-making, encourage critical assessment of evolving technologies, and promote higher-quality care for patients throughout the spine community.

Sincerely,

Sociedad Colombiana de Columna (SOCCOL)

On behalf of Sociedad Colombiana de Columna (SOCCOL), I am delighted to support Real World Evidence in Spine Surgery: 2026 Update. Its global orientation is one of its major strengths, particularly for regions where local practice patterns, resource constraints, and training pathways may differ from those reflected in conventional trial literature.

For surgeons practicing in heterogeneous environments, the book is valuable because it respects both scientific rigor and contextual reality. It recognizes that evidence must ultimately be interpreted through the lens of patient population, resource availability, training culture, and system-level constraints.

That orientation is especially important in regions where high-level evidence may not fully capture local practice realities or access-related decision pathways.

For those of us committed to raising standards while respecting regional differences in practice, this book offers an important model. I am pleased to endorse it and believe it will stimulate thoughtful discussion across the Americas and beyond.

The editors, Kai-Uwe Lewandrowski, Alexander Richard Vaccaro, Morgan P. Lorio, Paul Park, Rossano Kepler Alvim Fiorelli, and Benedikt W. Burkhardt, are to be congratulated for producing a volume that will support informed surgical judgment, critical appraisal of new technologies, and higher-quality patient care across the spine community.

Sincerely,

Sociedad Mexicana de Endoscopia de Columna (SOMEEC)

As President of Sociedad Mexicana de Endoscopia de Columna (SOMEEC), I am pleased to endorse Real World Evidence in Spine Surgery: 2026 Update, an ambitious and timely volume that gives endoscopic and minimally invasive spine care the kind of rigorous, practice-facing analysis our field urgently needs.

What makes this book distinctive is its willingness to examine the full pathway from evidence generation to real-world adoption. The chapters on tubular versus endoscopic lumbar decompression, transforaminal endoscopic lumbar decompression, cervical endoscopic surgery, and anterior/endoscopic cervical indications are especially relevant to societies like ours because they address implementation, training, and practice variation rather than merely technical enthusiasm.

The chapters devoted to lumbar and cervical endoscopic strategies are likely to be particularly influential for surgeons refining indications and training pathways.

For these reasons, I believe this book will be of lasting value to spine surgeons, trainees, researchers, and policy leaders interested in how endoscopic and minimally invasive procedures should be evaluated and implemented. I commend the editorial team for producing a work that is rigorous, current, and genuinely useful to the global spine community.

The editors, Kai-Uwe Lewandrowski, Alexander Richard Vaccaro, Morgan P. Lorio, Paul Park, Rossano Kepler Alvim Fiorelli, and Benedikt W. Burkhardt, are to be congratulated for producing a volume that will support informed surgical judgment, critical appraisal of new technologies, and higher-quality patient care across the spine community.

Sincerely,

Brain Mapping and Therapeutics (SBMT)

On behalf of the Society for Brain Mapping and Therapeutics (SBMT), I am pleased to endorse Real World Evidence in Spine Surgery: 2026 Update. This volume is especially valuable because it approaches innovation not as a slogan or assumption, but as something that must be tested, compared, and validated through real clinical practice.

At a time when new technologies often enter surgical care more quickly than traditional evidence pathways can fully mature, the book provides a thoughtful and balanced framework for distinguishing what is promising, what is established, and what still warrants careful evaluation. That perspective is both timely and necessary.

A particular strength of this work is its measured tone. Rather than celebrating novelty for its own sake, it emphasizes the importance of disciplined assessment when emerging tools are introduced into patient care. This is exactly the kind of perspective the spine community needs as technology continues to reshape clinical decision-making.

For these reasons, I am pleased to recommend this book broadly to the international spine community. It is a mature, relevant, and well-balanced contribution to the ongoing discussion of technology-enabled surgical care and evidence-based innovation.

The editors—Kai-Uwe Lewandrowski, Alexander Richard Vaccaro, Morgan P. Lorio, Paul Park, Rossano Kepler Alvim Fiorelli, and Benedikt W. Burkhardt—are to be congratulated for producing a volume that will strengthen informed surgical judgment, encourage critical appraisal of emerging technologies, and support higher-quality patient care across the spine field.

Sincerely,

Sociedad Venezolana de Cirugía de Columna (SVCC)

On behalf of the Sociedad Venezolana de Cirugía de Columna (SVCC), it is our honor to endorse Real World Evidence in Spine Surgery: 2026 Update. This publication makes an important and timely contribution to spine surgery, especially in its examination of endoscopic methods in contemporary clinical settings.

The editors have produced a volume that goes beyond a conventional review of published studies. By combining focused PICO-based chapters, current evidence summaries, and surgeon survey findings evaluated through Rasch methodology, the book presents a practical and well-balanced view of both the scientific literature and day-to-day surgical judgment.

One of its greatest strengths is the attention given to changes in clinical use over time. Rather than relying solely on isolated trial results, the text shows how new procedures are introduced, adapted, and applied across a range of treatment environments, offering a more realistic picture of present-day spine practice.

This book will be highly valuable to surgeons, teachers, investigators, and healthcare leaders who aim to assess new technologies carefully and advance patient care. Its broad international outlook and strong methodological foundation make it relevant across both regional and global spine communities.

We congratulate the editors—Kai-Uwe Lewandrowski, Alexander Richard Vaccaro, Morgan P. Lorio, Paul Park, Rossano Kepler Alvim Fiorelli, and Benedikt W. Burkhardt—on preparing a book that promotes thoughtful clinical judgment, careful evaluation of innovation, and continued progress in spine surgery.

Sincerely,

Sociedad Venezolana de Neurocirugía (SVNC)

On behalf of the Sociedad Venezolana de Neurocirugía (SVNC), it is our distinct honor to endorse Real World Evidence in Spine Surgery: 2026 Update. This publication represents a meaningful and timely contribution to the neurosurgical and spine communities, particularly in its evaluation of endoscopic techniques within real-world clinical practice.

The editors have developed a volume that extends beyond traditional literature summaries. Through a structured approach incorporating focused PICO-based chapters, up-to-date evidence reviews, and surgeon-derived insights analyzed using Rasch methodology, the book offers a comprehensive perspective that aligns scientific data with practical clinical experience.

A notable strength is its systematic reexamination of established surgical protocols within real-world clinical contexts. By assessing whether current practices remain appropriate in light of technological advances and improved understanding of disease biology, the text offers a dynamic perspective that goes beyond static trial evidence.

This work will be a valuable resource for neurosurgeons, spine specialists, educators, researchers, and healthcare leaders seeking to critically assess emerging technologies and improve patient outcomes. Its global perspective and analytical rigor ensure relevance across diverse practice environments.

We commend the editors—Kai-Uwe Lewandrowski, Alexander Richard Vaccaro, Morgan P. Lorio, Paul Park, Rossano Kepler Alvim Fiorelli, and Benedikt W. Burkhardt—for their leadership in producing a volume that advances evidence-based care, supports thoughtful clinical decision-making, and contributes to ongoing progress in spine surgery.

Sincerely,

World Congress of Minimally Invasive Spinal Surgery Techniques (WCMISST)

On behalf of the World Congress of Minimally Invasive Spinal Surgery Techniques (WCMISST), I am pleased to endorse Real World Evidence in Spine Surgery: 2026 Update. This volume is distinguished by its clear understanding that progress in spine surgery does not rest on novelty alone, but on the careful evaluation of techniques, outcomes, patient selection, and real-world application.

A major strength of this book is its balanced and thoughtful approach. Rather than presenting innovation as automatically beneficial, it emphasizes the importance of measured assessment and clinical relevance. In doing so, it reflects the way meaningful advancement in minimally invasive spine surgery actually occurs: through refinement, comparison, experience, and critical interpretation of evidence as it emerges in practice.

This perspective is especially valuable at a time when surgical technologies and techniques are evolving rapidly. The volume offers a practical and intellectually grounded framework for considering not only what is new, but what is effective, reproducible, and appropriate for patient care. That makes it highly relevant to surgeons committed to improving outcomes while maintaining scientific rigor.

For these reasons, I believe this book will be important not only as a contemporary reference, but also as a contribution to the broader discussion of quality, innovation, and value in spine surgery worldwide. It is a timely and substantial work that will serve the global spine community well.

The editors—Kai-Uwe Lewandrowski, Alexander Richard Vaccaro, Morgan P. Lorio, Paul Park, Rossano Kepler Alvim Fiorelli, and Benedikt W. Burkhardt—are to be congratulated for producing a volume that will support informed surgical judgment, encourage thoughtful evaluation of evolving technologies, and promote higher-quality care for patients across the field of spine surgery.

Sincerely,

World Federation of Spine Endoscopy (WFSE)

It is a privilege, in my capacity as President of World Federation of Spine Endoscopy (WFSE), to endorse Real World Evidence in Spine Surgery: 2026 Update. The editors have assembled a work that moves beyond promotional narratives and instead examines how endoscopic techniques perform, evolve, and are adopted in the real world.

Its chapter architecture is particularly effective: focused PICO questions and updated literature reviews are paired with surgeon survey data analyzed through Rasch methodology, allowing the reader to see not only what the literature reports, but also how spine surgeons actually navigate decompression choices, endoscopic indications, and evolving cervical and lumbar techniques.

The text is especially persuasive in showing that endoscopic surgery should be assessed through longitudinal practice patterns, not only through isolated trial snapshots.

This volume deserves wide circulation among surgeons, educators, researchers, and decision-makers involved in the future of endoscopic spine surgery. I congratulate the editors on a book that is methodologically serious, clinically grounded, and internationally relevant.

The editors, Kai-Uwe Lewandrowski, Alexander Richard Vaccaro, Morgan P. Lorio, Paul Park, Rossano Kepler Alvim Fiorelli, and Benedikt W. Burkhardt, are to be congratulated for producing a volume that will support informed surgical judgment, critical appraisal of new technologies, and higher-quality patient care across the spine community.

Sincerely,