Defining spine care: a framework for scope, standards, and bidirectional care transitions

Modern spine care is increasingly fragmented across operative and nonoperative disciplines, with inconsistent terminology, variable procedural standards, and uneven referral thresholds. These limitations can lead to duplicated services, delayed escalation when structural disease is present, premature escalation when operative targets are absent, and prolonged episodes of low-value care. This manuscript presents an implementation-oriented conceptual framework designed to improve transition reliability across the spine-care continuum. The framework was developed through targeted narrative synthesis of representative multisociety position statements, guideline-based procedural standards, value-oriented literature, and implementation-focused clinical policy analyses relevant to spine-care transitions. We propose four practical elements: (I) functional role definitions and accountability interfaces, with operative care anchored to biomechanics-informed accountability and rescue/revision capability, and nonoperative care anchored to evidence-based, goal-directed, time-bound care episodes; (II) explicit bidirectional handoff triggers for escalation to surgical evaluation and return to nonoperative management; (III) standardized procedural language and minimum expectations, including route-specific injection terminology, structured follow-up, and response-based repetition logic; and (IV) coordinated management of boundary-zone interventions, particularly those associated with durable biomechanical consequences or evolving evidence. This framework is intended to reduce care drift, improve safety and consistency, and support timely escalation and appropriate de-escalation. By standardizing terminology, clarifying accountability, and operationalizing bidirectional transitions, it offers a practical pathway to improve coordination, patient navigation, and value across multidisciplinary spine care.