{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,23]],"date-time":"2026-09-23T21:59:23Z","timestamp":1790200763214,"version":"4.1.0"},"reference-count":52,"publisher":"Ovid Technologies (Wolters Kluwer Health)","content-domain":{"domain":["lww.com","ovid.com"],"crossmark-restriction":true},"short-container-title":[],"abstract":"<jats:p>Spine surgery missions in low-resource settings can meaningfully close global gaps in access to care but require careful logistical and relational planning. Drawing on collaborative missions within 2 Jamaican hospital systems under the Back to Healing nonprofit initiative, we review financial realities, logistical barriers, ethical responsibilities, and human dimensions that define high-impact missions. Success depends on financial planning and transparency, equipment logistics, intraoperative adaptability, and operating room throughput, but equally on sustained partnership with host institutions and local teams. Patient selection carries particular ethical weight under resource constraints, and training and research opportunities further support long-term collaboration. Practical recommendations are offered for surgeons and institutions planning missions.<\/jats:p>","DOI":"10.2106\/jbjs.26.00480","type":"journal-article","created":{"date-parts":[[2026,9,23]],"date-time":"2026-09-23T21:00:11Z","timestamp":1790197211000},"update-policy":"https:\/\/doi.org\/10.1097\/lww.0000000000001000","source":"Crossref","is-referenced-by-count":0,"title":["Spine Surgery Missions in Low-Resource Settings"],"prefix":"10.2106","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-2475-4996","authenticated-orcid":false,"given":"Joseph E.","family":"Nassar","sequence":"first","affiliation":[{"name":"Department of Orthopaedic Surgery, University of Miami Leonard M. Miller School of Medicine, Miami, Florida"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1613-0072","authenticated-orcid":false,"given":"Nathaniel W.","family":"Jenkins","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, University of Miami Leonard M. Miller School of Medicine, Miami, Florida"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shamar","family":"Bailey","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, Kingston Public Hospital, Kingston, Jamaica"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0003-2839-8559","authenticated-orcid":false,"given":"Deandra","family":"Poyser","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, Kingston Public Hospital, Kingston, Jamaica"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0009-9878-562X","authenticated-orcid":false,"given":"Marcus","family":"John","sequence":"additional","affiliation":[{"name":"Back to Healing Group, International Spine Surgery Outreach Initiative, Snellville, Georgia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8167-5808","authenticated-orcid":false,"given":"Micheal","family":"Raad","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, University of Miami Leonard M. Miller School of Medicine, Miami, Florida"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9697-8999","authenticated-orcid":false,"given":"Shay","family":"Bess","sequence":"additional","affiliation":[{"name":"Colorado Scoliosis and Spine, Greenwood Village, Colorado"},{"name":"International Spine Study Group Foundation, Longmont, Colorado"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1299-7093","authenticated-orcid":false,"given":"Peyton","family":"Lawrence","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, University Hospital of the West Indies, Kingston, Jamaica"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ian","family":"Neil","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, Kingston Public Hospital, Kingston, Jamaica"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stephen","family":"George","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, Nicklaus Children\u2019s Hospital, Miami, Florida"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7803-3481","authenticated-orcid":false,"given":"Charla","family":"Fischer","sequence":"additional","affiliation":[{"name":"Back to Healing Group, International Spine Surgery Outreach Initiative, Snellville, Georgia"},{"name":"Department of Orthopaedic Surgery, New York University Grossman School of Medicine, New York, NY"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8523-1750","authenticated-orcid":false,"given":"Jaysson T.","family":"Brooks","sequence":"additional","affiliation":[{"name":"Back to Healing Group, International Spine Surgery Outreach Initiative, Snellville, Georgia"},{"name":"Department of Orthopaedic Surgery, University of Texas Southwestern Medical Center\/Scottish Rite for Children, Dallas, Texas"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5512-1713","authenticated-orcid":false,"given":"Emmanuel N.","family":"Menga","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, University of Miami Leonard M. Miller School of Medicine, Miami, Florida"},{"name":"Back to Healing Group, International Spine Surgery Outreach Initiative, Snellville, Georgia"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","published-online":{"date-parts":[[2026,9,23]]},"reference":[{"issue":"7","key":"bib1-20260923","doi-asserted-by":"crossref","first-page":"477","DOI":"10.2106\/JBJS.25.01208","article-title":"Obstacles to Spine Surgery in Limited-Resource Environments","volume":"108","author":"Sebaaly","year":"2026","journal-title":"J Bone Joint Surg Am."},{"issue":"10","key":"bib2-20260923","doi-asserted-by":"crossref","first-page":"e0287355","DOI":"10.1371\/journal.pone.0287355","article-title":"Clinical spine care partnerships between high-income countries and low-and-middle-income countries: A scoping review","volume":"18","author":"Lin","year":"2023","journal-title":"PLoS One."},{"issue":"8","key":"bib3-20260923","doi-asserted-by":"crossref","first-page":"858","DOI":"10.1016\/j.ijsu.2014.07.009","article-title":"Surgical care in low and middle-income countries: burden and barriers","volume":"12","author":"Ologunde","year":"2014","journal-title":"Int J Surg."},{"issue":"5","key":"bib4-20260923","doi-asserted-by":"crossref","first-page":"941","DOI":"10.1007\/s00268-011-1010-1","article-title":"Systematic review of barriers to surgical care in low-income and middle-income countries","volume":"35","author":"Grimes","year":"2011","journal-title":"World J Surg."},{"key":"bib5-20260923","doi-asserted-by":"crossref","first-page":"105956","DOI":"10.1016\/j.ijsu.2021.105956","article-title":"Economic impact of surgery on households and individuals in low income countries: A systematic review","volume":"90","author":"Platt","year":"2021","journal-title":"Int J Surg."},{"issue":"9993","key":"bib6-20260923","doi-asserted-by":"crossref","first-page":"569","DOI":"10.1016\/S0140-6736(15)60160-X","article-title":"Global Surgery 2030: evidence and solutions for achieving health, welfare, and economic development","volume":"386","author":"Meara","year":"2015","journal-title":"Lancet."},{"issue":"12","key":"bib7-20260923","doi-asserted-by":"crossref","first-page":"1834","DOI":"10.1089\/tmj.2022.0250","article-title":"Telemedical Support Using Smartphones for Spine Surgery in Low- and Middle-Income Countries","volume":"29","author":"Sommer","year":"2023","journal-title":"Telemed J E Health."},{"issue":"1","key":"bib8-20260923","doi-asserted-by":"crossref","first-page":"39","DOI":"10.1177\/2192568219853251","article-title":"Cost Analysis of Single-Level Lumbar Fusions","volume":"10","author":"Beckerman","year":"2020","journal-title":"Global Spine J."},{"issue":"1_suppl","key":"bib9-20260923","doi-asserted-by":"crossref","first-page":"14S","DOI":"10.1177\/2192568220971288","article-title":"Achieving Value in Spine Surgery: 10 Major Cost Contributors","volume":"11","author":"Philipp","year":"2021","journal-title":"Global Spine J."},{"issue":"16","key":"bib10-20260923","doi-asserted-by":"crossref","first-page":"1121","DOI":"10.1097\/BRS.0000000000004409","article-title":"Cost-utility Analysis of Neoadjuvant Teriparatide Therapy in Osteopenic Patients Undergoing Adult Spinal Deformity Surgery","volume":"47","author":"Raad","year":"2022","journal-title":"Spine (Phila Pa 1976)."},{"issue":"14","key":"bib11-20260923","doi-asserted-by":"crossref","first-page":"1009","DOI":"10.1097\/BRS.0000000000003442","article-title":"Cost-Utility Analysis of rhBMP-2 Use in Adult Spinal Deformity Surgery","volume":"45","author":"Jain","year":"2020","journal-title":"Spine (Phila Pa 1976)."},{"issue":"5","key":"bib12-20260923","doi-asserted-by":"crossref","first-page":"330","DOI":"10.1097\/BRS.0000000000004526","article-title":"A Five-Year Cost-Utility Analysis Comparing Synthetic Cage Versus Allograft Use in Anterior Cervical Discectomy and Fusion Surgery for Cervical Spondylotic Myelopathy","volume":"48","author":"Raad","year":"2023","journal-title":"Spine (Phila Pa 1976)."},{"issue":"3","key":"bib13-20260923","doi-asserted-by":"crossref","first-page":"587","DOI":"10.1007\/s43390-023-00818-3","article-title":"The cost-utility of intraoperative tranexamic acid in adult spinal deformity patients undergoing long posterior spinal fusion","volume":"12","author":"Cartagena-Reyes","year":"2024","journal-title":"Spine Deform."},{"issue":"23","key":"bib14-20260923","doi-asserted-by":"crossref","first-page":"7173","DOI":"10.3390\/jcm13237173","article-title":"Surgical Management of Adult Spinal Deformity Patients with Osteoporosis","volume":"13","author":"Baroudi","year":"2024","journal-title":"J Clin Med."},{"issue":"2","key":"bib15-20260923","doi-asserted-by":"crossref","DOI":"10.2106\/JBJS.RVW.24.00210","article-title":"Preoperative Optimization Strategies in Elective Spine Surgery","volume":"13","author":"Daniels","year":"2025","journal-title":"JBJS Rev."},{"issue":"2","key":"bib16-20260923","doi-asserted-by":"crossref","first-page":"E28","DOI":"10.1097\/BRS.0000000000005294","article-title":"Preoperative Iron Supplementation Mitigates the Risk of Postoperative Complications Associated With Iron Deficiency Anemia Following Lumbar Spinal Fusion","volume":"51","author":"Jain","year":"2026","journal-title":"Spine (Phila Pa 1976)."},{"issue":"4","key":"bib17-20260923","doi-asserted-by":"crossref","first-page":"997","DOI":"10.1007\/s43390-025-01065-4","article-title":"The impact of the social determinants of health on adolescent idiopathic scoliosis: a systematic review","volume":"13","author":"Paradkar","year":"2025","journal-title":"Spine Deform."},{"issue":"6","key":"bib18-20260923","doi-asserted-by":"crossref","first-page":"1178","DOI":"10.1016\/j.spinee.2024.12.012","article-title":"The impact of symptom duration on postoperative outcomes in patients undergoing anterior cervical discectomy and fusion: a systematic review and meta-analysis","volume":"25","author":"Nassar","year":"2025","journal-title":"Spine J."},{"issue":"13","key":"bib19-20260923","doi-asserted-by":"crossref","first-page":"969","DOI":"10.2106\/JBJS.25.00904","article-title":"Interbody Cages: Surface Technologies in Spinal Implants","volume":"108","author":"Nassar","year":"2026","journal-title":"J Bone Joint Surg Am."},{"issue":"18","key":"bib20-20260923","doi-asserted-by":"crossref","first-page":"2122","DOI":"10.2106\/JBJS.25.00031","article-title":"Development of a Spine Surgery Center of Excellence: Rationale, Design, Implementation, and Assessment of Outcomes","volume":"107","author":"Daniels","year":"2025","journal-title":"J Bone Joint Surg Am."},{"issue":"Suppl 2","key":"bib21-20260923","doi-asserted-by":"crossref","first-page":"S50","DOI":"10.1016\/S0140-6736(15)60845-5","article-title":"Cost of surgery and catastrophic expenditure in people admitted to hospital for injuries: estimates from a cohort study in Vietnam","volume":"385","author":"Nguyen","year":"2015","journal-title":"Lancet."},{"issue":"11","key":"bib22-20260923","doi-asserted-by":"crossref","first-page":"7261","DOI":"10.1097\/MS9.0000000000003844","article-title":"Navigating neurosurgical care in low- and middle-income countries from Africa: a narrative review of barriers and facilitators","volume":"87","author":"Kihunyu","year":"2025","journal-title":"Ann Med Surg (Lond)."},{"issue":"1","key":"bib23-20260923","doi-asserted-by":"crossref","first-page":"10","DOI":"10.1007\/s00268-014-2516-0","article-title":"Charitable platforms in global surgery: a systematic review of their effectiveness, cost-effectiveness, sustainability, and role training","volume":"39","author":"Shrime","year":"2015","journal-title":"World J Surg."},{"issue":"1","key":"bib24-20260923","doi-asserted-by":"crossref","first-page":"18","DOI":"10.1186\/s12992-018-0330-4","article-title":"Guidelines for responsible short-term global health activities: developing common principles","volume":"14","author":"Lasker","year":"2018","journal-title":"Global Health."},{"issue":"3","key":"bib25-20260923","doi-asserted-by":"crossref","first-page":"215","DOI":"10.1001\/archfaci.2011.1643","article-title":"Ethical conduct of humanitarian medical missions: I. Informed Consent","volume":"14","author":"Holt","year":"2012","journal-title":"Arch Facial Plast Surg."},{"issue":"11","key":"bib26-20260923","doi-asserted-by":"crossref","first-page":"439","DOI":"10.1007\/s12178-024-09917-8","article-title":"Global Health Inequities in Orthopaedic Care: Perspectives Beyond the US","volume":"17","author":"DeMaio","year":"2024","journal-title":"Curr Rev Musculoskelet Med."},{"key":"bib27-20260923","first-page":"102637","article-title":"Prevalence of spine surgery navigation techniques and availability in Africa: A cross-sectional study","volume":"68","author":"Kanmounye","year":"2021","journal-title":"Ann Med Surg (Lond)."},{"issue":"12","key":"bib28-20260923","doi-asserted-by":"crossref","first-page":"1173","DOI":"10.1080\/17434440.2023.2264767","article-title":"Regulation, approval, and access of spinal implants in low-middle-income countries: a narrative review and case study","volume":"20","author":"Ikwuegbuenyi","year":"2023","journal-title":"Expert Rev Med Devices."},{"issue":"5","key":"bib29-20260923","doi-asserted-by":"crossref","first-page":"333","DOI":"10.1016\/j.jspd.2014.05.003","article-title":"Best Practices in Intraoperative Neuromonitoring in Spine Deformity Surgery: Development of an Intraoperative Checklist to Optimize Response","volume":"2","author":"Vitale","year":"2014","journal-title":"Spine Deform."},{"issue":"1","key":"bib30-20260923","doi-asserted-by":"crossref","first-page":"6","DOI":"10.1016\/0013-4694(94)00235-D","article-title":"Somatosensory evoked potential spinal cord monitoring reduces neurologic deficits after scoliosis surgery: results of a large multicenter survey","volume":"96","author":"Nuwer","year":"1995","journal-title":"Electroencephalogr Clin Neurophysiol."},{"issue":"4","key":"bib31-20260923","doi-asserted-by":"crossref","first-page":"476","DOI":"10.1016\/j.otohns.2010.05.011","article-title":"Surgical missions to developing countries: Ethical conflicts","volume":"143","author":"Isaacson","year":"2010","journal-title":"Otolaryngol Head Neck Surg."},{"key":"bib32-20260923","first-page":"185725","article-title":"Effectiveness of international surgical program model to build local sustainability","volume":"2012","author":"Magee","year":"2012","journal-title":"Plast Surg Int."},{"issue":"20","key":"bib33-20260923","doi-asserted-by":"crossref","first-page":"1924","DOI":"10.2106\/JBJS.23.01414","article-title":"Clinical Practice Guidelines to Support Capacity Building in Orthopaedic Surgical Outreach: An International Consensus Building Approach","volume":"106","author":"Welch","year":"2024","journal-title":"J Bone Joint Surg Am."},{"issue":"3","key":"bib34-20260923","doi-asserted-by":"crossref","first-page":"549","DOI":"10.1097\/SLA.0000000000006058","article-title":"Defining a Framework and Evaluation Metrics for Sustainable Global Surgical Partnerships: A Modified Delphi Study","volume":"279","author":"Binda","year":"2024","journal-title":"Ann Surg."},{"issue":"4","key":"bib35-20260923","doi-asserted-by":"crossref","first-page":"828","DOI":"10.1016\/j.jpedsurg.2017.11.037","article-title":"Guidelines and checklists for short-term missions in global pediatric surgery: Recommendations from the American Academy of Pediatrics Delivery of Surgical Care Global Health Subcommittee","volume":"53","author":"Butler","year":"2018","journal-title":"J Pediatr Surg."},{"issue":"8","key":"bib36-20260923","doi-asserted-by":"crossref","first-page":"1368","DOI":"10.1016\/j.jcms.2018.05.037","article-title":"The contribution of telemedicine to humanitarian surgery","volume":"46","author":"Ambroise","year":"2018","journal-title":"J Craniomaxillofac Surg."},{"issue":"8","key":"bib37-20260923","doi-asserted-by":"crossref","first-page":"1855","DOI":"10.1007\/s00268-022-06549-2","article-title":"Telemedicine in Surgical Care in Low- and Middle-Income Countries: A Scoping Review","volume":"46","author":"Owolabi","year":"2022","journal-title":"World J Surg."},{"issue":"3","key":"bib38-20260923","doi-asserted-by":"crossref","first-page":"130","DOI":"10.6061\/clinics\/2017(03)01","article-title":"The influence of body image on surgical decisions in adolescent idiopathic scoliosis patients","volume":"72","author":"Borges","year":"2017","journal-title":"Clinics (Sao Paulo)."},{"issue":"6","key":"bib39-20260923","doi-asserted-by":"crossref","first-page":"910","DOI":"10.2106\/00004623-199072060-00018","article-title":"Influence of parental age on degree of curvature in idiopathic scoliosis","volume":"72","author":"Henderson","year":"1990","journal-title":"J Bone Joint Surg Am."},{"issue":"8","key":"bib40-20260923","doi-asserted-by":"crossref","first-page":"e61","DOI":"10.2106\/JBJS.L.00867","article-title":"Body image in patients with adolescent idiopathic scoliosis: validation of the Body Image Disturbance Questionnaire\u2014Scoliosis Version","volume":"96","author":"Auerbach","year":"2014","journal-title":"J Bone Joint Surg Am."},{"key":"bib41-20260923","first-page":"24","article-title":"Idiopathic scoliosis and quality of life","volume":"88","author":"Freidel","year":"2002","journal-title":"Stud Health Technol Inform."},{"issue":"3","key":"bib42-20260923","doi-asserted-by":"crossref","first-page":"e15","DOI":"10.2106\/JBJS.M.01189","article-title":"International health electives in orthopaedic surgery residency training","volume":"97","author":"Shultz","year":"2015","journal-title":"J Bone Joint Surg Am."},{"issue":"3","key":"bib43-20260923","first-page":"e24.00033","article-title":"The Current State of International Academic Partnerships in Orthopaedic Surgery Between High-Income and Low and Middle-Income Countries: A Systematic Review","volume":"9","author":"Flores","year":"2024","journal-title":"JB JS Open Access."},{"issue":"1","key":"bib44-20260923","doi-asserted-by":"crossref","first-page":"e000011","DOI":"10.1136\/bmjgh-2015-000011","article-title":"Global Surgery 2030: a roadmap for high income country actors","volume":"1","author":"Ng-Kamstra","year":"2016","journal-title":"BMJ Glob Health."},{"key":"bib45-20260923","first-page":"e22.00168","article-title":"Evaluation of Low- and Middle-Income Country Authorship in the Global Orthopaedic Literature","volume":"7","author":"Young","year":"2023","journal-title":"J Am Acad Orthop Surg Glob Res Rev."},{"key":"bib46-20260923","doi-asserted-by":"crossref","first-page":"6","DOI":"10.1051\/sicotj\/2023039","article-title":"Peer-reviewed publications in orthopaedic surgery from lower income countries: A comparative analysis","volume":"10","author":"Sabharwal","year":"2024","journal-title":"SICOT J."},{"issue":"1","key":"bib47-20260923","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1016\/j.jphys.2023.08.013","article-title":"Research from low-income and middle-income countries will benefit global health and the physiotherapy profession, but it requires support","volume":"70","author":"Sharma","year":"2024","journal-title":"J Physiother."},{"key":"bib48-20260923","doi-asserted-by":"crossref","first-page":"6","DOI":"10.1051\/sicotj\/2016042","article-title":"Impact of academic collaboration and quality of clinical orthopaedic research conducted in low- and middle-income countries","volume":"3","author":"Wu","year":"2017","journal-title":"SICOT J."},{"issue":"1","key":"bib49-20260923","doi-asserted-by":"crossref","first-page":"157","DOI":"10.1016\/j.athoracsur.2025.03.030","article-title":"Lessons from 19 Years of a Pediatric Heart Surgery Volunteer Program in Jamaica: Partnership, Teamwork, and Sustainability","volume":"120","author":"Ramdeen","year":"2025","journal-title":"Ann Thorac Surg."},{"issue":"2","key":"bib50-20260923","doi-asserted-by":"crossref","first-page":"154","DOI":"10.1001\/archsurg.2009.263","article-title":"Addressing the Millennium Development Goals from a surgical perspective: essential surgery and anesthesia in 8 low- and middle-income countries","volume":"145","author":"Kushner","year":"2010","journal-title":"Arch Surg."},{"issue":"11","key":"bib51-20260923","doi-asserted-by":"crossref","first-page":"944","DOI":"10.2106\/JBJS.N.01119","article-title":"Sustainability assessment of a short-term international medical mission","volume":"97","author":"Bido","year":"2015","journal-title":"J Bone Joint Surg Am."},{"issue":"3","key":"bib52-20260923","doi-asserted-by":"crossref","first-page":"E280","DOI":"10.1503\/cjs.010719","article-title":"A systematic review of global surgery partnerships and a proposed framework for sustainability","volume":"64","author":"Jedrzejko","year":"2021","journal-title":"Can J Surg."}],"container-title":["Journal of Bone and Joint Surgery"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.ovid.com\/10.2106\/JBJS.26.00480","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,9,23]],"date-time":"2026-09-23T21:00:19Z","timestamp":1790197219000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.ovid.com\/10.2106\/JBJS.26.00480"}},"subtitle":["Practical Considerations and Lessons Learned"],"short-title":[],"issued":{"date-parts":[[2026,9,23]]},"references-count":52,"URL":"https:\/\/doi.org\/10.2106\/jbjs.26.00480","relation":{},"ISSN":["0021-9355","1535-1386"],"issn-type":[{"value":"0021-9355","type":"print"},{"value":"1535-1386","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,9,23]]}}}