The Global Spine Care Initiative: model of care and implementation

Claire D. Johnson, Scott Haldeman, Roger Chou, Margareta Nordin, Bart N. Green, Pierre Côté, Eric L. Hurwitz, Deborah Kopansky-Giles, Emre Acaroğlu, Christine Cedraschi, Arthur Ameis, Kristi Randhawa, Ellen Aartun, Afua Adjei-Kwayisi, Selim Ayhan, Amer Aziz, Teresa Bas, Fiona Blyth, David Borenstein, O’Dane D. BradyPeter Brooks, Connie Camilleri, Juan M. Castellote, Michael B. Clay, Fereydoun Davatchi, Jean Dudler, Robert Dunn, Stefan Eberspaecher, Juan Emmerich, Jean Pierre Farcy, Norman Fisher-Jeffes, Christine Goertz, Michael Grevitt, Erin A. Griffith, Najia Hajjaj-Hassouni, Jan Hartvigsen, Maria Hondras, Edward J. Kane, Julie Laplante, Nadège Lemeunier, John Mayer, Silvano Mior, Tiro Mmopelwa, Michael Modic, Jean Moss, Rajani Mullerpatan, Elijah Muteti, Lillian Mwaniki, Madeleine Ngandeu-Singwe, Geoff Outerbridge, Shanmuganathan Rajasekaran, Heather Shearer, Matthew Smuck, Erkin Sönmez, Patricia Tavares, Anne Taylor-Vaisey, Carlos Torres, Paola Torres, Alexander van der Horst, Leslie Verville, Emiliano Vialle, Gomatam Vijay Kumar, Adriaan Vlok, William Watters, Chung Chek Wong, Jessica J. Wong, Hainan Yu, Selcen Yüksel

Research output: Contribution to journalArticlepeer-review

47 Scopus citations


Purpose: Spine-related disorders are a leading cause of global disability and are a burden on society and to public health. Currently, there is no comprehensive, evidence-based model of care for spine-related disorders, which includes back and neck pain, deformity, spine injury, neurological conditions, spinal diseases, and pathology, that could be applied in global health care settings. The purposes of this paper are to propose: (1) principles to transform the delivery of spine care; (2) an evidence-based model that could be applied globally; and (3) implementation suggestions. Methods: The Global Spine Care Initiative (GSCI) meetings and literature reviews were synthesized into a seed document and distributed to spine care experts. After three rounds of a modified Delphi process, all participants reached consensus on the final model of care and implementation steps. Results: Sixty-six experts representing 24 countries participated. The GSCI model of care has eight core principles: person-centered, people-centered, biopsychosocial, proactive, evidence-based, integrative, collaborative, and self-sustaining. The model of care includes a classification system and care pathway, levels of care, and a focus on the patient’s journey. The six steps for implementation are initiation and preparation; assessment of the current situation; planning and designing solutions; implementation; assessment and evaluation of program; and sustain program and scale up. Conclusion: The GSCI proposes an evidence-based, practical, sustainable, and scalable model of care representing eight core principles with a six-step implementation plan. The aim of this model is to help transform spine care globally, especially in low- and middle-income countries and underserved communities. Graphical abstract: These slides can be retrieved under Electronic Supplementary Material.[Figure not available: see fulltext.]

Original languageEnglish (US)
Pages (from-to)925-945
Number of pages21
JournalEuropean Spine Journal
StatePublished - Sep 1 2018


  • Global burden of disease
  • Musculoskeletal system
  • Quality of health care
  • Spinal diseases

ASJC Scopus subject areas

  • Surgery
  • Orthopedics and Sports Medicine


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