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The substantial importance of spine care/spine surgery and its socioeconomic impact on the present and future health care environment should be well understood by anyone involved in the medical field, public health, or social services. The global and regional dimensions of spine problems brought on through expanding, aging, and increasingly more disabled populations have been clearly demonstrated through the openly accessible database of the Global Burden of Disease project. For most regions and countries backand neck-related care is not only a leading but also growing entity among major health care domains. Increasingly, large-scale data gathering efforts are utilized to try to better understand resource utilization relative to spine care. Previously Global Spine Journal has presented in an editorial titled “Evidence-Based Medicine, Media, and Manipulation” a failed national effort in Germany performed in 2017 by a nongovernment not-for-profit organization (“Faktencheck Rücken”—translated as “Fact Check Spine”). This national-scale production claimed substantial and otherwise unexplained increases of spine procedures, which was accompanied by a predictable widespread negative media echo pertaining to potential self-serving motives of spine practitioners. The assertions as well as many aspects of the data gathering efforts that they were based on were rapidly debunked by German spine societies as erroneous. A foundational flaw of this data mining exercise was the primary absence of actual spine care content experts. Not surprisingly, there was no corrective media update, so the negative public perception about spine surgery of this big data report probably remains lingering in the minds of people somewhere in the endless digital media vaults for all future times to come. A study in contrast can be seen in the “Get It Right First Time” (GIRFT) Spinal Services project published in the United Kingdom in January 2019 by the NHS (National Health Service). This collaborative and comprehensive multispecialty program is chaired by a practicing orthopedic surgeon, Professor Tim Briggs, CBE, who also holds a number of other leadership positions within the NHS. The spine report itself was authored by a clinically active consultant spine surgeon, Mr Mike Dutton, and orthopedic spine surgeon from Exeter and a neurosurgical spine surgeon from Newcastle, Mr Justin Nissen. In contrast to the German report this effort was also from inception onwards supported by the leading professional spine, orthopedic, and neurological surgery societies and experienced statisticians. A further noteworthy difference lies in the fact that the authors did not just perform a data mining expedition but actually visited 127 Spine surgery units in the United Kingdom and performed structured interviews. (Note of potential conflict of interest: Mr Hutton has previously been a published author in Global Spine Journal.) A remarkable insight to the value of personal visits beyond data mining alone can be gleaned from an introductory comment made by lead author. He was “struck by the passionate commitment of the clinical staff towards the NHS as a force for good in society.” Organized into 13 chapters, this 101-page report covers diverse aspects of spine care from utilization of nonsurgical interventional therapies to life-and-death impact of spinal cord injury care. Every chapter is followed by recommendations, actions, and a timescale, which allows stakeholders to assess progress and implementation or impediment evaluations. Public health experts will find interest in looking at a classic hot button topic such as practice variations, for instance, demonstrated by the data on compliance with nationally established nonoperative back pain and radiculopathy pathways (chapter 2). All data is presented in a de-identified non-blame approach, by simply showing variations and allowing for future exploration of reasons for such differences. For hospital purchasing managers and surgeons alike, the remarkable variations of implant costs among regions and hospitals will provide foundation for greater coordination of value basics (chapter 13). Highcost rare-use technologies such as spinal cord stimulators were revealed as having surprisingly high revision and explanatory numbers resulting in the concrete proposal to make their use contingent upon participation in a national data registry. The introduction of more general novel surgical technologies is also addressed with the interesting example of dynamic spine stabilization and interspinous spacers, Global Spine Journal 2019, Vol. 9(7) 689-691 a The Author(s) 2019 Article reuse guidelines: sagepub.com/journals-permissions DOI: 10.1177/2192568219872741 journals.sagepub.com/home/gsj

Big Spine Data Put to Good Use: The NHS Sets an Example