Preface

The field of spine surgery has witnessed extraordinary advancements over the past few decades, driven by relentless innovation, rigorous research, and the pursuit of better outcomes for patients suffering from painful spinal disorders. As the discipline evolves, the dichotomy between evidence-based medicine—anchored in systematic reviews and randomized controlled trials (RCTs)—and real-world clinical practice has become increasingly apparent to many. This book series, Real World Evidence in Spine Surgery – 2026 Update, embarks on an ambitious journey to explore this critical intersection, offering insights that promise to redefine how we evaluate and implement spine care in the future.

At the heart of this 2026 Update lies a compelling premise: the standards of care defined by the highest levels of clinical evidence often diverge from the realities of day-to-day surgical practice. While RCTs and meta-analyses provide invaluable data, they frequently operate within rigid parameters that may not capture the complexity of real-world patient populations, the nuances of surgical decision-making, or the variability in surgeon expertise and proficiency. Conversely, the collective wisdom gained from years of clinical experience, patient interactions, and procedural innovation often remains underrepresented in the literature.

Real World Evidence in Spine Surgery series bridges this gap by systematically comparing state-of-the-art published research with data derived from the real-world experiences of spine surgeons. Through an innovative methodology incorporating psychometric survey data and advanced Rasch analysis, this book sheds light on how surgeons perceive best practices, highlighting areas of agreement and disagreement with established evidence. It provides a platform for open discourse, aiming to reconcile these differences and, in doing so, advance the field.

This book’s scope is as ambitious as it is necessary. From spinal anatomy, biomechanics, deformities, and trauma to minimally invasive techniques and motion preservation, each chapter explores the most pressing topics in spine surgery. By using the PICO framework to guide systematic reviews and aligning these with carefully constructed survey questions, the book ensures a balanced, objective examination of each subject. The editorial team, comprising leading experts from diverse backgrounds and disciplines, has crafted a comprehensive resource that will be invaluable not only to surgeons but to healthcare decision-makers, researchers, and policymakers.

The work presented here is groundbreaking in its ability to address fundamental questions: How do we define success in spine surgery? How can we reconcile clinical evidence with the practical realities of patient care? How can we use real-world data to refine our understanding of high-value procedures, ensuring the sustainability of spine surgery in an era of increasing demands and constrained resources?

As the reader explores this book, the editors invite you to embrace its spirit of inquiry and reflection. It challenges conventional wisdom and invites physicians involved in the delivery of spine care to engage in a critical dialogue about the future of our field. The editors are confident that the insights gained from this work will not only inform clinical practice but also inspire further research and innovation.

It is with great admiration for the editors, contributors, and all those who have brought this project to fruition that our editorial team commends Real World Evidence in Spine Surgery to its readers. May it serve as a valuable resource in our collective mission to improve spine care for the patients we are privileged to serve.