Spine endoscopic surgery establishment for disc disease (Neurocore-SENSED): an open and decentralized consensus

Abstract

Introduction: Endoscopic spine surgery (ESS) has evolved considerably, yet there remains a lack of consensus on patient selection, technical specifications, and outcome reporting. This heterogeneity hinders collaborative efforts to establish comprehensive evidence-based practices.

Research question: To develop core outcome sets (COS) and reporting guidelines for ESS for disc disease through an international consensus.

Material and methods: We established a multidisciplinary, international expert panel through literature review and peer-to-peer recruitment. Between January and April 2025, we employed a three-round modified Delphi technique. Items spanned three domains: patient characteristics, practices and outcomes. Propositions endorsed by ≥ 75 % of participants were classified as 'strong' and included in the COS. Those with 50-75 % were reconsidered in the subsequent round, requiring ≥66 % for inclusion as 'moderate'.

Results: The panel consisted of 77 spine surgeons from Europe (61 %), Asia (14 %), and North America (13 %), with 58 completing all three rounds. Of 183 items (165 initially provided, 18 participant add-ons), agreement was reached on 99 items (82 strongly and 17 moderately). Key consensus elements included demographics, comorbidities, clinical complaints, imaging findings, surgical indications, technical parameters, and outcome measures such as pain scores, functional outcomes, and complications.

Discussion and conclusion: We established the Neurocore-SENSED framework, comprising COS and reporting guidelines for ESS for disc disease. This consensus addresses fundamental heterogeneity in ESS research, complementing existing nomenclature and indication-specific guidelines. By enhancing consistency, comparability, and quality of ESS research, this framework aims to accelerate the development of evidence-based practices that optimize patient outcomes in this rapidly advancing field.

Keywords: Consensus; Delphi technique; Disc diseases; Endoscopic spine surgery; Intervertebral disc; Minimally invasive; Spine endoscopy; Standardization.