Operational phenotyping for chronic low back pain: a narrative review and methodology for developing routing and escalation pathways across spine care

作者：Lewandrowski KU, Pumberger M, Schomig F, Harhangi BS, Vaccaro AR, Lorio MP · 发表于：Annals of palliative medicine · 年份：2026 · DOI：10.21037/apm-2026-1-0026 · 研究领域：Low back pain (LBP)、clinical pathways、phenotyping、shared decision-making、stratified care

BACKGROUND AND OBJECTIVE: Chronic low back pain (CLBP) is clinically heterogeneous and generates substantial symptom burden, functional limitation, psychological distress, work disability, and health-care utilization. Existing phenotyping approaches often describe subgroups but do not specify how subgroup assignment changes routing, conservative-care dose, imaging, interventional escalation, surgical evaluation, or outcome monitoring. The objective of this narrative review was to define operational phenotyping as a practical method for developing routable, auditable spine-care pathways and to distinguish this methodology from descriptive subgrouping, Subgroups for Targeted Treatment Back Screening Tool (STarT Back)-style risk stratification, and machine-learning phenotyping. METHODS: We conducted a narrative review using structured methods. PubMed/MEDLINE was the primary database, supplemented by Embase, Cumulative Index to Nursing and Allied Health Literature (CINAHL), PsycINFO, Cochrane Central Register of Controlled Trials (CENTRAL), Scopus/Web of Science when available, guideline and trial-registry review, and reference-list screening. Searches covered January 2000 through January 2026. Studies were synthesized using an Inputs-Decision-Pathway-Outcome (IDPO) framework. The Berlin deep-phenotyping program was used as a contextual exemplar of multidomain measurement, not as evidence of treatment efficacy. KEY CONTENT AND FINDINGS: The synthesis yielded five operational fi...