SINE20 is an international advocacy initiative founded in 2019 by the Saudi Spine Society, EUROSPINE, the North American Spine Society, and the German Spine Society. Its mission is to improve spine care globally by developing evidence-based policy recommendations for G20 countries aimed at reducing the growing burden of spine disease. Disorders of the spine are among the leading causes of disability worldwide, placing a substantial burden on individuals, health systems, and national economies. Spine-related conditions can lead to chronic pain, functional impairment, loss of productivity, and long-term socioeconomic consequences. Addressing this challenge requires coordinated advocacy, education, and informed government policies that promote value-based, high-quality spine care while controlling healthcare costs.

Each year, SPINE20 convenes an international summit that culminates in the development of consensus-based, evidence-driven policy recommendations. These recommendations are formally published and disseminated to inform national and global health policy discussions, particularly within G20 platforms. To date, more than 35 professional spine care societies from around the world are actively engaged in SPINE20, reflecting its broad international and multidisciplinary collaboration. The inaugural SPINE20 meeting was held in Riyadh, Saudi Arabia, in 2020. Subsequent summits have taken place in Rome, Italy (2021); Bali, Indonesia (2022); New Delhi, India (2023); Rio de Janeiro, Brazil (2024); and Cape Town, South Africa (2025). The next SPINE20 Summit will be held in New York, United States, on 18–19 September 2026.