The Evolvement of the 100 Most Cited Articles in Spine Surgery in the Last Decade Compared to All-Time

Abstract

Background: Decision-making in spine surgery is continuously shaped by advancements in the field through evidence-based medicine. This is demonstrated through the evolution of the quality and impact of scientific research within the field of spine surgery. To date, there is limited literature investigating interval changes in methodological rigor of scientific investigation within the field of spine surgery.

Methods: The top 100 cited articles were recorded for manuscripts from January 1, 2013, to December 31, 2023, and the top 100 most cited manuscripts of all time for spine surgery, via the Scopus abstract and citation database. Data collected included year of publication, article type, level of evidence , methodological index for non-randomized studies (MINORs)/(Physiotherapy Evidence Database(PEDro) Scale.

Results: Most studies for all-time cohort (33.8%) were reported as level IV and over the last decade (41.1%) were level III. The average MINOR scores for comparative studies was 18.1 for the all-time cohort and 15.7 for the decade cohort (P < 0.05). The average MINORs scores for noncomparative studies were 9.7 for the all-time cohort and 8.98 for the decade cohort (P = 0.278). The average PEDro score was 0.72 for the all-time cohort and 0.61 for the decade cohort (P > 0.05). The number of level IV studies decreased from 33.8% in the all-time cohort to 12.3% in the last decade with increases in level II studies from 0% all-time to 6.85% in the last decade (P < 0.05).

Conclusions: An overall increase in the level of evidence over time within the field of spine surgery was demonstrated with an associated decreased methodologic rigor within recent nonrandomized investigations. A focus on enhancing the quality of investigation is prudent to guide evidence-based practice in spine surgery.

Keywords: Level of evidence; Most-cited; Spine surgery; Study metrics.