Stronger Together: Collaboration of Asia Pacific With the Rest of the World in Research and Education to Advance the Science, Art, and Practice of Spinal Surgery ================================================================================================================================================================= * Hyeun-Sung Kim * Pang Hung Wu * Il-Tae Jang * collaboration * spine surgery * endoscopic spine surgery Recent advances in medicine have increased the life expectancy of humans.1 Consequently, clinicians must manage to improve spinal disorders specific to the elderly and aging spine. Demographic trends make it incumbent on spine surgeons to recognize the unique challenges in caring for older patients with spinal pathology. Pathologies, such as osteoporosis and degenerative deformities, must be identified and dealt with. As we progress, innovations in surgical techniques and innovative technologies have resulted in improved patient care. Combined with these innovations, there is a better understanding of indications and contraindications, which has allowed surgeons to effectively target pathologies to decompress, reconstruct, or both while also reducing adverse effects (pain, psychological stress, and collateral damage) and complications (infection and adjacent segment pathology). There is an increasing number of publications addressing adverse outcomes and reducing collateral damage from endoscopic and minimally invasive spine surgeries, motion preservation, artificial intelligence, and robotics and navigation systems. These technologies and innovative procedures allow for maximal functional recovery and thus play a vital role in quality of life.2 While the number of publications is higher among orthopedic surgeons than neurosurgeons in bibliometric data of spine journals, there is an increasing trend of publications by neurosurgeons and collaborative research between orthopedic surgeons and neurosurgeons.3 The collaboration and exchange of ideas between spine surgeons from diverse neurosurgical and orthopedic backgrounds are essential. The differences in surgical training and exposure to surgical techniques during residency lead to differences in perspective and ideas for managing spinal conditions. This phenomenon of peer disagreement—that is, scientific argument by equally competent persons with contrary beliefs on a given topic—has led to the development of new techniques and innovations through combined research activities. There is a significant increase in spinal surgeons in the Asia Pacific region with considerable research and development in the medical field. Spinal surgeons in this region constitute a sizable portion of many international medical societies. The inherent difference (between the East and West) in ethnicity, body habitus, society norms, and culture leads to different spinal disease manifestations, patient satisfaction measures, and outcomes in surgical procedures.3,4 There is a strong interest in the Asia Pacific region in spinal endoscopy with a higher number of publications and percentage of surgeons performing spinal endoscopy in the spinal surgeons population.5 This East–West dichotomy benefits the exchange of ideas to contribute to the advancement of medicine and the improved health and quality of life of mankind.2 I do not doubt that this special issue of the *International Journal of Spine Surgery* will become a core forum for spine scholars in the Asia Pacific region, especially neurosurgery spine scholars, to discuss these areas. As researchers, clinicians, and surgeons in the Asia Pacific region, we hope that you will join the efforts and journey of the *International Journal of Spine Surgery*. ## Footnotes * **Funding** The authors received no financial support for the research, authorship, and/or publication of this article. * **Declaration of Conflicting Interests** The authors report no conflicts of interest in this work. * **Disclosures** The authors report no financial disclosures with respect to the research, authorship, and/or publication of this article. * This manuscript is generously published free of charge by ISASS, the International Society for the Advancement of Spine Surgery. Copyright © 2022 ISASS. To see more or order reprints or permissions, see [http://ijssurgery.com](http://ijssurgery.com). ## References 1. 1. Daniels AH , Gundle K , Hart RA . Collateral adverse outcomes after lumbar spine surgery. Instr Course Lect. 2016;65:291–297. 2. 2. Kim H-S , Wu PH , Jang I-T . Development of endoscopic spine surgery for healthy life: to provide spine care for better, for worse, for richer, for poorer, in sickness and in health. Neurospine. 2020;17(Suppl 1):S3–S8. doi:10.14245/ns.2040188.094 [CrossRef](https://www.ijssurgery.com/lookup/external-ref?access_num=10.14245/ns.2040188.094&link_type=DOI) 3. 3. Jain M , Mohnaty CR , Sahoo J , Radhakrishnan RV , Biswas M . A bibliometric analysis of the spine journals. J Clin Orthop Trauma. 2021;16:219–225. doi:10.1016/j.jcot.2021.02.005 [CrossRef](https://www.ijssurgery.com/lookup/external-ref?access_num=10.1016/j.jcot.2021.02.005&link_type=DOI) 4. 4. Lin G-X , Kotheeranurak V , Mahatthanatrakul A , et al . Worldwide research productivity in the field of full-endoscopic spine surgery: a bibliometric study. Eur Spine J. 2020;29(1):153–160. doi:10.1007/s00586-019-06171-2 [CrossRef](https://www.ijssurgery.com/lookup/external-ref?access_num=10.1007/s00586-019-06171-2&link_type=DOI) 5. 5. Kim JS , Yeung A , Lokanath YK , Lewandrowski KU . Is Asia truly a hotspot of contemporary minimally invasive and endoscopic spinal surgery? J Spine Surg. 2020;6(Suppl 1):S224–S236. doi:10.21037/jss.2019.12.13 [CrossRef](https://www.ijssurgery.com/lookup/external-ref?access_num=10.21037/jss.2019.12.13&link_type=DOI)