Worldwide Research Productivity in the Field of Minimally Invasive Spine Surgery: A 20-year Survey of Publication Activities

A Century of Evolution in Spine Surgery Publications: A Bibliometric Analysis of the Field From 1900 to 2023

BACKGROUND AND OBJECTIVES

Spine surgery has advanced in concert with our deeper understanding of its elements. Narrowly focused bibliometric analyses have been conducted previously, but never on the entire corpus of the field. Using big data and bibliometrics, we appraised the entire corpus of spine surgery publications to study the evolution of the specialty as a scholarly field since 1900.

METHODS

We queried Web of Science for all contents from 13 major publications dedicated to spine surgery. We next queried by topic [topic = (spine OR spinal OR vertebrae OR vertebral OR intervertebral OR disc OR disk)]; these results were filtered to include articles published by 49 other publications that were manually determined to contain pertinent articles. Articles, along with their metadata, were exported. Statistical and bibliometric analyses were performed using the Bibliometrix R package and various Python packages.

RESULTS

Eighty-five thousand five hundred articles from 62 journals and 134 707 unique authors were identified. The annual growth rate of publications was 2.78%, with a surge after 1980, concurrent with the growth of specialized journals. International coauthorship, absent before 1970, increased exponentially with the formation of influential spine study groups. Reference publication year spectroscopy allowed us to identify 200 articles that comprise the historical roots of modern spine surgery and each of its subdisciplines. We mapped the emergence of new topics and saw a recent lexical evolution toward outcomes- and patient-centric terms. Female and minority coauthorship has increased since 1990, but remains low, and disparities across major publications persist.

CONCLUSION

The field of spine surgery was borne from pioneering individuals who published their findings in a variety of journals. The renaissance of spine surgery has been powered by international collaboration and is increasingly outcomes focused. While spine surgery is gradually becoming more diverse, there is a clear need for further promotion and outreach to under-represented populations.

Incidence and treatment trends of infectious spondylodiscitis in South Korea: A nationwide population-based study

The incidence of infectious spondylodiscitis (IS) has increased in recent years due to an increase in the numbers of older patients with chronic diseases, as well as patients with immunocompromise, steroid use, drug abuse, invasive spinal procedures, and spinal surgeries. However, research focusing on IS in the general population is lacking. This study investigated the incidence and treatment trends of IS in South Korea using data obtained from the Health Insurance Review and Assessment Service. A total of 169,244 patients (mean age: 58.0 years) diagnosed from 2010 to 2019 were included in the study. A total of 10,991 cases were reported in 2010 and 18,533 cases in 2019. Hence, there was a 1.5-fold increase in incidence rate per 100,000 people from 22.90 in 2010 to 35.79 in 2019 (P < 0.05). The incidence rate of pyogenic spondylodiscitis per 100,000 people increased from 15.35 in 2010 to 33.75 in 2019, and that of tuberculous spondylodiscitis decreased from 7.55 in 2010 to 2.04 in 2019 (P < 0.05, respectively). Elderly individuals ≥ 60 years of age accounted for 47.6% (80,578 patients) of all cases of IS. The proportion of patients who received conservative treatment increased from 82.4% in 2010 to 85.8% in 2019, while that of patients receiving surgical treatment decreased from 17.6% to 14.2% (P < 0.05, respectively). Among surgical treatments, the proportions of corpectomy and anterior fusion declined, while proportion of incision and drainage increased (P < 0.05, respectively). The total healthcare costs increased 2.9-fold from $29,821,391.65 in 2010 to $86,815,775.81 in 2019 with a significant increase in the ratio to gross domestic product. Hence, this population-based cohort study demonstrated that the incidence rate of IS has increased in South Korea. The conservative treatment has increased, while the surgical treatment has decreased. The socioeconomic burden of IS has increased rapidly.

A bibliometric analysis of idiopathic inflammatory myopathies from 1982 to 2021

OBJECTIVE

There has been an increasing number of literature related to idiopathic inflammatory myopathies (IIM) in the past few decades. However, there is a lack of intuitive and systematic analysis of research on IIM. Therefore, this study aimed to perform a bibliometric analysis to identify the current trends and hotspots of research on IIM.

METHODS

Articles and reviews on IIM published during 1982-2021 were acquired from the Web of Science Core Collection (WoSCC) database. VOSviewer application was applied to conduct a network analysis of the keywords, institutions, and countries. The top 100 most-cited publications regarding IIM were analyzed.

RESULTS

In total, 665 publications were included. Globally, the USA produced the most articles on IIM (144). Karolinska Institutet was the institution with the most outputs (47). Rheumatology ranked on top of journals, with 47 IIM-related documents collecting a total of 1420 citations. In the area of IIM documents, biomarkers were the most common research theme. According to the co-occurrence analysis of keywords, "cardiac involvement," "criteria," and "refractory adult" were identified as significant future research centers.

CONCLUSION

The scientific literature on IIM has advanced rapidly in the past 4 decades. The classification criteria, treatment, and extramuscular manifestations of IIM have been identified as promising research frontiers in the field. The global status and trends of the IIM literature from a bibliometric aspect can offer a helpful guidance and new insight for researchers and medical workers in the domain. Key Points • This study reveals the topic trends and knowledge structure of idiopathic inflammatory myopathies literature over the last 40 years. • This study identifies potential future research hotspots, including "cardiac involvement," "criteria," and "refractory adult."

An international analysis of stem cell research in intervertebral disc degeneration

Stem cell therapy has been increasingly investigated as a promising strategy for intervertebral disc degeneration (IDD). However, no international analysis of stem cell research has yet been conducted. This study aimed to analyze the major characteristics of published reports of stem cell use for IDD and to present a global insight into stem cell research. The study period spanned from the inception of the Web of Science database to 2021. A search strategy using specific keywords was implemented to retrieve relevant publications. The numbers of documents, citations, countries, journals, article types, and stem cell types were evaluated. A total of 1170 papers were retrieved. The analysis showed a significant increase in the number of papers over time (p < 0.001). High-income economies accounted for the majority of papers (758, 64.79 %). China produced the most articles (378, 32.31 %), followed by the United States (259, 22.14 %), Switzerland (69, 5.90 %), United Kingdom (54, 4.62 %), and Japan (47, 4.02 %). The United States ranked first in terms of the number of citations (10,346), followed by China (9177) and Japan (3522). Japan ranked first in terms of the number of citations per paper (74.94), followed by United Kingdom (58.54) and Canada (53.74). When standardized by population, Switzerland ranked first, followed by Ireland and Sweden. When gross domestic product was considered, Switzerland ranked first, followed by Portugal and Ireland. The number of papers was positively correlated with gross domestic product (p < 0.001, r = 0.673); however, there was no significant correlation with population (p = 0.062, r = 0.294). Mesenchymal stem cells were the most investigated stem cells, followed by nucleus pulposus-derived stem cells and adipose-derived stem cells. A sharp increase in stem cell research was observed in the field of IDD. China produced the most, although several European countries were more productive relative to their populations and economies.

Global research productivity in the field of discectomy on lumbar disc herniation: A systematic bibliometric analysis

Objective

To evaluate the global research productivity in the field of discectomy for lumbar disc herniation (LDH) through bibliometric analysis and mapping knowledge domains.

Methods

A systematic literature search was performed on the Web of Science (WoS), including the Science Citation Index Expanded (SCIE) database and PubMed. The number of publications, countries of publications, journals of publications, total citation frequency, impact factors of journals, and Institutional sources were analyzed by Microsoft Excel 2019, the Online Analysis Platform of Bibliometrics, and VOSviewer. Hotspots were also analyzed and visualized based on VOSviewer.

Results

A total of 2,066 papers were identified. The United States ranked first in the number of total citations (7,970). China ranked first in the number of publications (556, 26.9%), which has surpassed the United States in terms of the number of publications published annually since 2016. Wooridul Spine Hospital published the most papers (43). For journals, Spine has published the largest number of papers (289) in this field with the most citation frequencies (6,607). Hotspots could be divided into three clusters: surgery, lumbar disc herniation, and diagnoses. The most recent topic that appeared was symptomatic re-herniation.

Conclusions

The United States is the most significant contributor to the development of discectomy for LDH. The current research focus of discectomy on LDH was the comparison between surgical approaches and evaluation of current minimally invasive discectomy. At present, minimally invasive techniques, such as endoscopic discectomy, cannot completely replace non-endoscopic discectomy (open discectomy and microdiscectomy) through bibliometric analysis and mapping knowledge domains.

Research trends and frontiers on antiphospholipid syndrome: A 10-year bibliometric analysis (2012-2021)

Objectives: A growing body of studies related to antiphospholipid syndrome (APS) have been published in recent years. Nevertheless, there is a lack of visualized and systematic analysis in the literature on APS. Hence, this study sought to conduct a bibliometric analysis to identify research status and discover frontiers in the field. Methods: Articles and reviews concerning APS were acquired from the Web of Science Core Collection (WoSCC) database. CiteSpace, VOSviewer and a bibliometric online analysis platform were employed to conduct a visualization and knowledge-map analysis. Results: A total of 1,390 publications regarding APS were identified. Globally, Italy contributed the most publications. The University of Padua was the most productive institution. Lupus ranked first in both the most published and most co-cited journals. Savino Sciascia and Spiros Miyakis were the most prolific and most co-cited authors, respectively. "Vitamin K antagonists (VKA)" and "immunoglobulin A (IgA)" were current research foci. Burst analysis of keywords suggested that "neutrophil extracellular trap (NET)," "direct oral anticoagulant (DOAC)," "open label," "outcome," "hydroxychloroquine (HCQ)," and "arterial thrombosis (AT)" were significant future research frontiers. Conclusion: The scientific literature on APS has increased steadily in the past 10 years. The clinical studies on the treatment and mechanism research of APS are recognized as promising research hotspots in the domain of APS. The research status and trends of APS publications from the bibliometric perspective can provide a practical guide and important reference for subsequent studies by researchers and physicians in the domain.

Global Trends Of The Researches On Ossification Of Posterior Longitudinal Ligament In Thoracic Spine: A Bibliometric And Visualization Study

STUDY DESIGN

Bibliometric analysis OBJECTIVE: Thoracic ossification of the posterior longitudinal ligament (TOPLL) was a rare but intractable disease, and was the second leading cause of thoracic myelopathy. This study aimed to illustrate the overall knowledge structure, and development trends of TOPLL, using a bibliometric analysis and newly developed visualization tools.

METHODS

Research datasets were acquired from the Web of Science. The literature search was also limited to articles that were published until Oct 30, 2021. VOS viewer and Citespace software was provided to analyze the data and generate visualization knowledge maps. Annual trend of publications, distribution, H-Index status, co-authorship status and research hotspots were analyzed.

RESULTS

206 publications met the requirement. Japan published most papers (92), both total citations (1574) and H-index (24) ranked first of all the countries. The most productive organizations were Peking University (22). The most productive authors were Yamazaki M (18). The most productive journals were Spine (33). Diagnosis and treatment on the accuracy of surgical segments, prognosis of patients, and gene research were the research hotspots in the recent years.

CONCLUSION

The study showed an upward trend with a stable rise in recent years. Japan is country with the highest productivity, not only in quality, but also in quantity. Peking University and Spine have been the largest contributor. Indeed, this study provides great insights to the growth and development of TOPLL. Moreover, it will contribute to the growth of the international frontier.

Global Trends of Researches on Lumbar Spinal Stenosis: A Bibliometric and Visualization Study

STUDY DESIGN

Bibliometric and visualization analysis.

OBJECTIVE

Lumbar spinal stenosis (LSS) has become a common health problem and the most frequent indication for spinal surgery. This study aimed to illustrate the overall knowledge structure, and development trends of LSS, using a bibliometric analysis and newly developed visualization tools.

MATERIALS AND METHODS

Research data sets were acquired from the Web of Science. The time span was defined as "2000-2019". VOS viewer and Citespace software was provided to analyze the data and generate visualization knowledge maps. Annual trend of publications, distribution, H-index status, co-authorship status and research hotspots were analyzed.

RESULTS

A total of 1934 publications met the requirement. The United States published most papers (521, 26.9%), both total citations (17,626) and H-index (61) ranked first of all the countries. The most productive organizations on LSS is Seoul National University (50). Spine (43) published the most papers on LSS. Quality of life, risk factor, disability, double blind trials, and decompression surgery are the research hotspots in the recent years.

CONCLUSION

The number of publications showed an upward trend with a stable rise in recent years. The United States is a country with the highest productivity, not only in quality, but also in quantity. Seoul National University has been the largest contributor in this field. Spine is the best journal related to LSS. Quality of life, risk factor, disability, and decompression surgery are the research hotspots in the recent years. Indeed, this study provides a new insight to the growth and development of LSS. Moreover, it will contribute to the growth of the international frontier of LSS.

Scientific Productivity in Rheumatoid Arthritis: A Global Survey of Research Activity

OBJECTIVES

Assessment of scientific productivity provides a macroscopic view of research activity in a specific field. However, no analyses of rheumatoid arthritis (RA) have been published to date. Thus, this study aimed to investigate the characteristics of studies published on RA worldwide.

METHODS

The Web of Science database was searched for articles on RA published between 2017 and 2019. Analysis parameters included the number of articles, number of times each publication was cited, country, journal, and research output adjusted by population and gross domestic product.

RESULTS

Overall, 16,936 publications were identified. The United States was the largest contributor (17.71%), followed by China (17.17%), Japan (6.37%), the United Kingdom (5.82%), and Italy (4.76%). High-income economies (69.98%) ranked first in productivity, followed by middle- (30%) and low-income economies (0.02%). Significant correlations were found between research productivity and population (r = 0.461, p = 0.000), as well as gross domestic product (r = 0.786, p = 0.000). Publications from the United States received the highest number of total citations (21,669), followed by China (10,952) and the United Kingdom (7846). Austria had the highest average citations (16.18), followed by Norway (8.19) and the United Kingdom (7.98). When normalized by population, the leading country was Denmark, followed by the Netherlands and Sweden. When adjusted by gross domestic product, Denmark ranked first in publications on RA, followed by the Netherlands and Greece.

CONCLUSION

The United States emerged as the largest contributor to the field of RA research. Countries with large populations and economies tended to have higher research productivity. Multiple countries in Europe performed better in research output when normalized by population and economy sizes.

Global production of nursing research: A 10-year survey of subspecialty nursing journals

AIM

This study aimed to investigate the characteristics of global productivity of nursing research in subspecialty nursing journals and to provide a general view of global nursing research.

METHODS

On 10 January 2020, Web of Science was used for research collection. Publications in subspecialty nursing journals from 2015 to 2019 were analysed.

RESULTS

A total of 34 275 publications were retrieved. The United States (15 155) ranked first, followed by Australia (2439), China (2076), Brazil (1803) and the United Kingdom (1602). High-income economies produced 82.26% of the total number of publications. Research production was not significantly correlated with the population (p = 0.113, r = 0.412), whereas it was positively correlated with gross domestic product (p = 0.030, r = 0.541). The United States had the highest number of total citations (46 297). The Netherlands ranked highest when analysing mean citations, followed by Finland and Australia. Sweden ranked highest after correcting for gross domestic product, followed by Australia and Finland. Australia was the most productive nation when adjusted by population, followed by Sweden and Norway.

CONCLUSION

The United States is the leader in nursing research productivity. Countries with large economies tend to make greater contributions to global nursing research. Some European countries and Australia were found to be more prolific when stratified by population size and economic activity.

Global Research Trends in Robotic Applications in Spinal Medicine: A Systematic Bibliometric Analysis

OBJECTIVE

We systematically evaluated the global research trends in robotic application on the spine through bibliometric analysis and mapping knowledge domains.

METHODS

A systematic literature search was performed of the PubMed and Web of Science, including the Science Citation Index Expanded, databases. The number, countries, journals, and authors of the publications, total citations, average publication year, and institution sources were analyzed using Microsoft Excel, the Online Analysis Platform of Bibliometrics, and VOSviewer. The hotspots were analyzed and visualized using VOSviewer.

RESULTS

We identified a total of 2135 publications. The United States ranked first in the number of publications (n = 824; 38.63%) and frequency of citations (n = 29,075). Northwestern University had the highest number of publications (n = 67) and Harvard University the highest number of citations (n = 4198). The Journal of NeuroEngineering and Rehabilitation published the largest number of reports (n = 73), and the most frequently cited journal was Nature (n = 3844 citations). The research hotspots were divided into 3 categories analyzed by VOSviewer: rehabilitation, basic science, and surgery. According to the average publication year, the most recent hotspot was radiation exposure, and the earliest hotspot was radiosurgery.

CONCLUSIONS

The number of studies of robotic application on the spine has continued to increase. The United States was the greatest contributor to robotic applications on the spine. Robot-assisted rehabilitation for neurological and orthopedic lesions is still a major research hotspot. The range of robotic applications on the spine has expanded from assisted rehabilitation to assisted rehabilitation and surgery.

A Bibliometric Analysis and Visualization of Current Research Trends in the Treatment of Cervical Spondylotic Myelopathy

STUDY DESIGN

Bibliometric analysis.

OBJECTIVE

Cervical spondylotic myelopathy (CSM) has become the most common cause of spinal cord dysfunction. Many topics of CSM still remain controversial. This study aimed to illustrate the overall knowledge structure and development trends of CSM.

METHODS

Research data sets were acquired from the Web of Science database and the time span was defined as "2000 to 2019." VOS viewer and Citespace software was used to analyze the data and generate visualization knowledge maps. Annual trends of publications, distribution, H-index status, co-authorship status, and research hotspots were analyzed.

RESULTS

A total of 2367 publications met the requirement. The largest number of articles was from the United States, followed by Japan, China, Canada, and India. The highest H-index was found for articles from the United States. The highest number of articles was published in Spine. The cooperation between the countries, institutes, and authors were relatively weak. Cervical sagittal alignment, predictive factor, diffusion tensor imaging, and the natural history of CSM may become a frontier in this research field.

CONCLUSION

The number of publications showed an upward trend with a stable rise. Most of the publications are limited to a few countries and institutions with relatively weak interaction. The United States, Canada, Japan, China, and India have made significant contributions to the field of CSM. The United States is the country with the highest productivity, not only in quality but also in quantity. Cervical sagittal alignment, predictive factor, diffusion tensor imaging, and the natural history of CSM are the research hotspots in the recent years.

Using Kano diagrams to display the most cited article types, affiliated countries, authors and MeSH terms on spinal surgery in recent 12 years

Background

Citation analysis has been increasingly applied to assess the quantity and quality of scientific research in various fields worldwide. However, these analyses on spinal surgery do not provide visualization of results. This study aims (1) to evaluate the worldwide research citations and publications on spinal surgery and (2) to provide visual representations using Kano diagrams onto the research analysis for spinal surgeons and researchers.

Methods

Article abstracts published between 2007 and 2018 were downloaded from PubMed Central (PMC) in 5 journals, including Spine, European Spine Journal, The Spine Journal, Journal of Neurosurgery: Spine, and Journal of Spinal Disorders and Techniques. The article types, affiliated countries, authors, and Medical subject headings (MeSH terms) were analyzed by the number of article citations using x-index. Choropleth maps and Kano diagrams were applied to present these results. The trends of MeSH terms over the years were plotted and analyzed.

Results

A total of 18,808 publications were extracted from the PMC database, and 17,245 were affiliated to countries/areas. The 12-year impact factor for the five spine journals is 5.758. We observed that (1) the largest number of articles on spinal surgery was from North America (6417, 37.21%). Spine earns the highest x-index (= 82.96). Comparative Study has the highest x-index (= 66.74) among all article types. (2) The United States performed exceptionally in x-indexes (= 56.86 and 44.5) on both analyses done on the total 18,808 and the top 100 most cited articles, respectively. The most influential author whose x-index reaches 15.11 was Simon Dagenais from the US. (3) The most cited MeSH term with an x-index of 23.05 was surgery based on the top 100 most cited articles. The most cited article (PMID = 18164449) was written by Dagenais and his colleagues in 2008. The most productive author was Michael G. Fehlings, whose x-index and the author's impact factor are 13.57(= √(13.16*14)) and 9.86(= 331.57/33.64), respectively.

Conclusions

There was a rapidly increasing scientific productivity in the field of spinal surgery in the past 12 years. The US has extraordinary contributions to the publications. Furthermore, China and Japan have increasing numbers of publications on spinal surgery. This study with Kano diagrams provides an insight into the research for spinal surgeons and researchers.

Characterizing the Surgeon Learning Curve in Instrumented Minimally Invasive Spinal Surgery: Does the Evidence Account for Training and Experience? A Systematic Literature Review

STUDY DESIGN

This was a systematic literature review.

OBJECTIVE

The purpose of this systematic literature review was to aggregate all evidence characterizing the learning curve of instrumented minimally invasive surgery (MIS) techniques in spinal surgery and summarize what, if any, consideration has been given to surgeon training and experience.

SUMMARY OF BACKGROUND DATA

MIS techniques have become prevalent in spine surgery given the ability to diminish the intraoperative footprint, translating to quicker patient recovery, and improved long-term outcomes. However, technical demand on the surgeon can be significant, particularly during the procedural adoption (learning curve) phase. Many studies have sought to quantify the duration and severity of these learning curve phases, with the intent to characterize MIS procedural appropriateness and safety. However, while these studies are robust regarding outcome metrics, it is not well understood whether they adequately characterize surgeon training and experience.

METHODS

A systematic literature review was performed in the PubMed and MEDLINE databases in accordance with the PRISMA guidelines. All inclusion articles were screened for statements regarding surgeon experience/training. Statements were further classified by the types of metrics/variables utilized to establish a contextual history of experience/training. Descriptive statistics were reported.

RESULTS

Initial search criteria yielded 458 articles, 12 met final inclusion. Seven articles (58.3%) attempted a summary statement of experience which acknowledged at least one of the following metrics: total years in practice (41.7%), years/number of cases performed using the traditional/gold-standard technique (16.7%), specification of residency/fellowship training (16.7%), use/nonuse of cadaveric or course/lab training (16.7%), and/or design of operating team (8.3%). No articles considered experience as a quantitative variable in their study analyses.

CONCLUSIONS

Spine MIS learning curve studies for instrumented fusion procedures provide inadequate context/characterization of surgeon experience and training. Future efforts leveraging learning curve methodology utilized in other surgical specialties would be beneficial.

Contribution of Iranian scholars to medical sciences: A holistic overview of 140-years publication

Background: This study investigated the trends in the scientific output of Iran published in PubMed indexed journals. To the best of our knowledge, there was no previous study to examine the Iranian scientific output in all fields of health and biomedical sciences. Methods: Using a bibliometric approach, we tracked 140 years (between 1877 and 2016) of Iranian scientific productions in PubMed. The journals which papers widely published over them were analyzed. The metadata of journals was extracted from Web of Science (WoS), Scopus, and Scimago Journal & Country Rank. The Gross Domestic Product (GDP) data was elaborated from the World Bank to evaluate the relationship with research output. We used Pearson's correlation coefficient at p<0.01 significance level and reported the data in a scatterplot. Results: We identified 106 226 documents produced by Iranian authors in journals indexed in PubMed since 1877. The number of papers climbed dramatically in 2000 and afterward, and this was consistent with the country's GDP. Although the scientific contribution of Iranian researchers is remarkable, 67% of papers (26 978 out of 106 226) were published in local Journals categorized into quartile 3 and 4 of WoS and Scopus. The study shows that GDP growth has had a positive influence on publication output (r=0.738, p<0.001). Conclusion: This is the first study with a panorama view of Iran's contribution to biomedical literature. Based on the results of our survey, although the number of Iranian publications rose over time but they are mostly published in low ranked journals. Health policy-makers advise reconsidering the criteria for measuring research activities. Improving policies will help researchers to publish in higher ranked journals.

Does Robot Navigation and Intraoperative Computed Tomography Guidance Help with Percutaneous Endoscopic Lumbar Discectomy? A Match-Paired Study

OBJECTIVE

To evaluate the efficacy and safety of robot-assisted percutaneous endoscopic lumbar discectomy (rPELD) using a specially designed orthopaedic robot with an intraoperative computed tomography-equipped suite for treatment of symptomatic lumbar disc herniation and compare rPELD with fluoroscopy-assisted percutaneous endoscopic lumbar discectomy (fPELD).

METHODS

We retrospectively reviewed and compared demographic data, radiologic workups, and patient-reported outcomes of 39 patients treated with rPELD and 78 patients treated with fPELD at our institution between January 2019 and December 2019.

RESULTS

Our data showed that a single-shot puncture in the rPELD group was significantly more precise compared with 4.12 ± 1.71 trials in the fPELD group (P < 0.001). There was an overall reduction of fluoroscopy (21.33 ± 3.89 times vs. 33.06 ± 2.92 times, P < 0.001), puncture-channel time (13.34 ± 3.03 minutes vs. 15.03 ± 4.5 minutes, P = 0.038), and total operative time (57.46 ± 7.49 minutes vs. 69.40 ± 12.59 minutes, P < 0.001) using the rPELD technique versus the fPELD technique. However, there were no significant differences in patient-reported outcomes, length of hospital stay, and complication rate between the 2 groups (P > 0.05).

CONCLUSIONS

Taken together, our data indicate that rPELD provides a precise skin entry point and optimal trajectory for puncture, which increases the success rate of PELD, negating the need for revision surgery. However, further studies are required to confirm the superiority and application of the rPELD technique.

Defining Common Features in High Impact and Highly Cited Journal Articles on Pancreatic Tumors: An Analysis of 1044 Studies over the Past Decade

INTRODUCTION

Surgical researchers seek to publish their findings in esteemed surgical journals to advance science and their careers. A detailed investigation of study and manuscript attributes in a specific research area, like pancreatic neoplasia, may yield informative insights for researchers looking to maximize research impact.

OBJECTIVES

We analyzed publications related to pancreatic surgery primarily focused on pancreatic and periampullary tumors in order to identify elements associated with acceptance into high impact journals and a high likelihood of future citations.

METHODS

A comprehensive review of nine surgical journals was performed between 2010-19. Journals were grouped based on impact factor into high (>3), medium (1-3) and low (<1) impact categories. Each publication was annotated to identify study topic, methodology and statistical approach. Findings were compared according to journal impact and number of citations to identify predictors of success across these two domains.

RESULTS

A total of 1,044 out of 21,536 (4.8%) articles published in the index journals were related to pancreatic tumors. The most common focus of study was perioperative outcomes and complications (46.7%). There was significantly more number of authors, participating institutions, countries, and randomized clinical trials in higher impact journals as well as high-cited articles (p<0.05). Though advanced statistical analysis was used more commonly in high-impact journals (p<0.05), it did not translate to higher citations (p>0.05).

CONCLUSION

Pancreatic neoplasia continues to be extensively studied in surgical literature. Specific elements of study methodology and design were identified as potentially key attributes to acceptance in high impact journals and citation success.

Access to Technology and Education for the Development of Minimally Invasive Spine Surgery Techniques in Latin America

OBJECTIVE

To evaluate access to the technologies and education needed to perform minimally invasive spine surgery (MISS) in Latin America.

METHODS

We designed a questionnaire to evaluate surgeons' practice characteristics, access to different technologies, and training opportunities for MISS techniques. The survey was sent to members and registered users of AO Spine Latin from January 6-20, 2020. The major variables studied were nationality, specialty (orthopedics or neurosurgery), level of hospital (primary, secondary, tertiary), number of surgeries performed per year by the spine surgeon, types of spinal pathologies commonly managed, and number of MISS performed per year. Other variables involved specific access to different technologies: intraoperative fluoroscopy, percutaneous screws, cages, tubular retractors, microscopy, intraoperative computed tomography, neuronavigation imaging, and bone morphogenetic protein. Finally, participants were asked about main obstacles to performing MISS and their access to education on MISS techniques in their region.

RESULTS

The questionnaires were answered by 306 members of AO Spine Latin America across 20 different countries. Most answers were obtained from orthopedic surgeons (57.8%) and those with over 10 years of experience (42.4%). Most of the surgeons worked in private practice (46.4%) and performed >50 surgeries per year (44.1%), but only 13.7% performed >50 MISS per year, mainly to manage degenerative pathologies (87.5%). Most surgeons always had access to fluoroscopy (79%). Only 26% always had access to percutaneous screws, 24% to tubular retractors, 34.3% to cages (anterior lumbar interbody fusion, lateral lumbar interbody fusion, or transforaminal lumbar interbody fusion), and 43% to microscopy. Regarding technologies, 71% reported never having access to navigation, 83% computed tomography, and 69.3% bone morphogenetic protein. The main limitations expressed for widely used MISS technologies were the high implant costs (69.3%) and high navigation costs (49.3%). Most surgeons claimed access to online education activities (71%), but only 44.9% reported access to face-to-face events and 28.8% to hands-on activities, their limited access largely because the courses were expensive (62.7%) or few courses were available on MISS in their region (51.3%).

CONCLUSIONS

Most surgeons in Latin America have limited resources to perform MISS, even in private practice. The main constraints are implant costs, access to technologies, and limited face-to-face educational opportunities.

A systematic investigation on the research publications that have used the medical expenditure panel survey (MEPS) data through a bibliometrics approach

Purpose

This study aimed to examine how Medical Expenditure Panel Survey (MEPS) data have been used to support scientific discoveries in biomedical and health sciences, and provide insight to researchers who are interested in using MEPS regarding collaborations and dissemination of research output.

Design/methodology/approach

A bibliometric approach was used to systematically examine the publications that used MEPS data and were indexed by PubMed and Web of Science (WoS). Microsoft Excel and bibliometric tools (WoS and VOSviewer) were utilized for quantitative and bibliometric network analysis. The measures were investigated on the total number of publications by year, research categories, source journals, other datasets/databases co-used with MEPS, funding sources, collaboration patterns, and research topics.

Findings

A total of 1,953 eligible publications were included in this study with the numbers growing significantly over time. MEPS data were primarily used in healthcare services, public environmental and occupational health research. The journals that published the most papers using MEPS were all in the healthcare research area. Twenty-four other databases were found to be used along with MEPS. Over 3,200 researchers from 1,074 institutions in 25 countries have contributed to the publications. Research funding was supported from federal, private, local, and international agencies. Three clusters of research topics were identified among 235 key terms extracted from titles and abstracts.

Originality/value

Our results illustrated the broad landscape of the research efforts that MEPS data have supported and substantiated the value of AHRQ's effort of providing MEPS to the public.

Bibliometric and Visualized Analysis of Scientific Publications on Atlantoaxial Spine Surgery Based on Web of Science and VOSviewer

BACKGROUND

Atlantoaxial spine surgery is a challenge to spinal surgeons because of its proximity to neurovascular structures. This study aimed to identify and analyze the scientific publications in atlantoaxial spine surgery from different countries and institutions.

METHODS

Clarivate Analytics Web of Science was used to search all articles for information on atlantoaxial spine surgery. The annual research, countries, journals, authors, institutions, citation frequency, and journal metrics were extracted. These results from countries and hotspots (keywords in publications) were subjected to co-occurrence analysis using VOSviewer, after which the top 100 most-cited articles were analyzed further.

RESULTS

A total of 3161 articles were included. A trend toward an increasing number of publications on atlantoaxial spine surgery in recent years was evident. Among all countries, the United States contributed the most publications. Seth Gordhandas Sundarda Medical College had the highest number of publications among institutions. Among all research categories, fixation and fusion were the most common areas discussed. The screw-rod system described in the most-cited article (cited 823 times) appeared to be the most popular fixation method. With the development of C1 and C2 screw technology, the screw-rod system is becoming increasingly popular.

CONCLUSIONS

The atlantoaxial spine surgery literature has grown continuously in recent years. The United States is the largest contributor in this field. Fixation and fusion are the most common areas, and fixation-related studies should be closely followed. The screw-rod fixation system is becoming increasingly popular.

Worldwide research productivity in the field of full-endoscopic spine surgery: a bibliometric study

PURPOSE

To investigate the quantity and quality of articles in the field of full-endoscopic spine surgery (FESS) from different countries and assess characteristics of worldwide research productivity.

METHODS

Articles published from 1997 to July 23, 2018, were screened using the Web of Science database. All studies were assessed for the following parameters: the number of total publications, h-index, contribution of countries, authors, journals, and institutions.

RESULTS

A total of 408 articles were identified between 1997 and 2018. Between 1997 and 2017, the number of published articles tended to increase by 41 times. The largest number of articles was from China (30.15%), followed by South Korea (28.68%), the USA (13.97%), Germany (9.31%), and Japan (4.90%). The highest h-index was found for articles from South Korea (23), followed by the USA (18), Germany (16), China (11), and Japan (7). The highest number of articles was published in World Neurosurgery (12.50%), followed by Pain Physician (10.29%), Spine (6.62%), European Spine Journal (4.66%), and Journal of Neurosurgery: Spine (4.17%). Wooridul Spine Hospital published the largest number of articles (10.29%), followed by Tongji University (5.88%), University of Witten/Herdecke (5.39%), Brown University (5.15%), and Third Military Medical University (3.43%).

CONCLUSIONS

The number of articles published in the field of FESS has increased rapidly in the past 20 years. In terms of quantity, China is the most contributive country based on the number of publications. High-quality papers as measured by h-index and the large quantity is from South Korea (second only to China). These slides can be retrieved under Electronic Supplementary Material.

Robotic Guidance in Minimally Invasive Spine Surgery: a Review of Recent Literature and Commentary on a Developing Technology

PURPOSE OF REVIEW

Minimally invasive spine surgery (MIS) and robotic technology are growing in popularity and are increasing utilized in combination. The purpose of this review is to identify the current successes, potential drawbacks, and future directions of robotic guidance for MIS compared to traditional techniques.

RECENT FINDINGS

Recent literature highlights successful incorporation of robotic guidance in MIS as a consistently accurate method for pedicle screw placement. With a short learning curve and low complication rates, robot guidance may also reduce the use of fluoroscopy, operative time, and length of hospital stay. Recent literature suggests that incorporating robotic guidance in MIS improves the accuracy of pedicle screw insertion and may have added benefits both intra- and postoperatively for the patient and provider. Future research should focus on direct comparison between MIS with and without robotic guidance.

Top 100 cited articles on infection in orthopaedics: A bibliometric analysis

PURPOSE

The infection is an essential problem in the clinical practice in orthopedics. The bibliometric analysis was conducted to evaluate the top 100 cited articles on infection in orthopaedics.

METHODS

The Web of Science (WoS) Core Database was comprehensively searched from 1975 to 2017, and the literature search was limited in Science Citation Index Expanded (SCI-E). The subject terms included "infection", "infectious", and "infect*". All retrieved articles were filtrated by selecting the subspecialty of "Orthopedics". The searching results were listed by citation times to identify the top 100 cited articles. Significant information was elicited, including the authors, journals, countries, institutions, published year, and types of publication.

RESULTS

A significant increase was observed in the number of annual publications focusing on infection in orthopedics worldwide. Each of the top 100 cited articles was cited more than 150 times. Total citation times was positively associated with citation times in 2016 (P <.01) and mean citation times per year (P <.01). Conversely, age of the article was negatively associated with citation times in 2016 (P <.01) and mean citation times per year (P <.01). Besides, citation times in 2016 was positively related to mean citation times per year (P <.01). The United States was the most productive country, surgery was the most popular subspecialty and Journal of Bone and Joint Surgery American Volume was the most popular journal.

CONCLUSION

Infection in orthopaedics has attracted more and more researchers' concern. As for the top 100 cited articles, there were significant relationships among total citation times, citation times in 2016 and mean citation times per year as well as age of the article. The United States was the most productive country, surgery was the most popular subspecialty and Journal of Bone and Joint Surgery American Volume was the most popular journal.

Worldwide research productivity in the field of back pain: A bibliometric analysis

BACKGROUND

This study aimed to show the world research productivity in the field of back pain and to help researchers follow the scientific development and promote the cooperation in this field.

METHODS

Web of Science (WoS) database was searched from 1995 to 2016 without other restrictions. The keywords were as follows: "lumbar NEAR pain," "back pain," "dorsalgia," "backache," "lumbago," "back NEAR disorder," and "discitis." The following information of retrieved articles was analyzed: countries/territories, journals, publication year, authors, citation reports, and institutions. Publication activity was further adjusted for countries by gross domestic product (GDP) and population size.

RESULTS

A total of 50,970 articles were retrieved in WoS database from 1995 to 2016. The United States published the biggest number of articles (16,818, 33.00%), followed by England (4,582, 8.99%), Germany (3,871, 7.60%), Canada (3,613, 7.09%), and Australia (3,063, 6.01%). Sweden ranked the first after adjusted for publication, and Netherlands ranked the first after adjusted for GDP. Besides, there was positive correlation between total number of publications and GDP for each country (P < .05). Harvard University was the most productive institution (917, 1.80%), Maher CG was the most productive author (229, 0.45%) and Spine was the most popular journal (3605, 7.07%) in the field of back pain research. Moreover, the article titled "Clinical importance of changes in chronic pain intensity measured on an 11-point numerical pain rating scale" in Pain had the highest citations (1749).

CONCLUSION

There was a significant increase in annual publications concerning back pain research worldwide. The total number of publications was positively associated with GDP in main productive countries. The United States was the most productive country, Harvard University was the most productive institution, Maher CG was the most productive author and Spine was the most popular journal in the field of back pain.

Concentric Stereotactic Technique of Percutaneous Endoscopic Transforaminal Discectomy and Radiation Exposure to Surgeons

OBJECTIVE

In percutaneous endoscopic transforaminal discectomy (PETD), surgeons are exposed to intraoperative radiographic radiation over a long-term career, which may be correlated with high risk of iatrogenic radiation hazards. The purpose of this prospective cohort study was to assess the impact of concentric stereotactic technique on radiation exposure to surgeons in PETD.

METHODS

Patients who underwent conventional PETD were regarded as group A, whereas those undergoing PETD with concentric stereotactic technique were considered as group B. The primary outcomes were cumulative radiation dose to the surgeon's eye, thyroid gland, and breast.

RESULTS

A total of 34 patients were treated in group A and 30 patients were treated in group B. The cumulative radiation dose of the eye per operation was 0.017 (0.58/34) mSv in group A and 0.010 (0.31/30) mSv in group B, which meant a reduction of 41.18%. The cumulative radiation dose of the thyroid gland per operation was 0.018 (0.60/34) mSv in group A and 0.011 (0.33/30) mSv in group B, which meant a reduction of 38.89%. The cumulative radiation dose of the chest per operation was 0.039 (1.33/34) mSv in group A and 0.023 (0.70/30) mSv in group B, which meant a reduction of 41.03%. There were no significant differences in hospital stay, visual analog scale score of waist and leg pain, Oswestry Disability Index score, MacNab satisfaction, and complications between the 2 groups (P > 0.05).

CONCLUSIONS

The concentric stereotactic technique can effectively reduce radiation exposure to surgeons by about 40%.

Global scientific productivity in the field of PET: a 10-year survey of research activities

OBJECTIVE

The objective of this study was to assess global research output in the field of PET and to provide a general picture of PET research.

MATERIALS AND METHODS

Publications on PET from 2007 to 2016 were identified using the Web of Science. The total number of papers, the number of papers adjusted by gross domestic product (GDP)/population size, total citations, and average citations were investigated.

RESULTS

A total of 40 670 papers were identified in the field of PET between 2007 and 2016. The number of papers published per year were significantly increased during this period (P=0.000). High-income countries published the maximum papers (89.95%), followed by middle-income countries (10.05%), whereas no papers were published by authors from low-income countries. The USA published the largest number of papers (11 936), followed by Japan (3667), Germany (3424), China (2508), and the UK (2424), and the USA had the highest total number of citations (361 498). The UK had the highest average citations (31.81). Positive correlations were found between the total number of papers and GDP (P=0.000, r=0.909)/population (P=0.000, r=0.772). When normalized by GDP, Denmark ranked the first (23.56), followed by The Netherlands (17.18) and Belgium (15.32). When adjusted for population, Denmark ranked the first (111.55), followed by The Netherlands (87.91) and Switzerland (86.93).

CONCLUSION

Global scientific production represents a rapid increase in the PET field in recent years. The majority of PET papers are from high-income countries. The USA is the most prolific country, whereas some smaller European countries may be more prolific relative to their GDP/population.

A 14-year literature survey on spine-related clinical research output by orthopedic surgeons from mainland China

BACKGROUND

In recent years, China is increasingly playing an active role in various fields of biomedical research. Many bibliometric studies have provided valuable insights to different fields of clinical studies. However, similar evaluation on spine surgery-related clinical research is still limited. We herein aimed to examine the scientific publications by orthopedic spine surgeons from mainland China within a 14-year period.

METHODS

Articles were identified in PubMed using predetermined query terms. Descriptive statistics were calculated, and T tests, Chi-squared tests, and regression analysis were conducted on the number of publications, impact factors (IFs), citations, region of the study, and associated medical subject headings (MeSHs).

RESULTS

A total of 1498 articles were identified and the annual number of publications, citations, and IFs all increased exponentially. The average IF was significantly higher in 2007 to 2013 than 2000 to 2006. Most publications were from Shanghai and Beijing and the 5 most productive administrative regions generated 70% of all publications. Analysis of associated MeSHs suggested research topics became more heterogeneous over the study period.

CONCLUSION

This was the first comprehensive evaluation on the clinical research output by orthopedic spine surgeons from mainland China. The annual number of publications and citations both increased significantly; however, research was highly concentrated in a handful of administrative regions.

Isocentric Navigation for the Training of Percutaneous Endoscopic Transforaminal Discectomy: A Feasibility Study

Background

Percutaneous endoscopic transforaminal discectomy (PETD) is usually chosen for lumbar disc herniation due to its obvious advantages such as small incision and absence of nerve or muscular traction. However, learning PETD is a great challenge for inexperienced surgeons.

Objective

The study aimed to investigate whether isocentric navigation would be beneficial in PETD training.

Methods

A total of 117 inexperienced surgeons were trained with PETD at L2/3, L3/4, L4/5, and L5/S1 on the cadavers without (Group A n=58) or with (Group B n=59) isocentric navigation. Puncture times, fluoroscopy times, exposure time, and radiation dose were recorded and analyzed. Questionnaires were conducted before and after the training program.

Result

Isocentric navigation could improve young surgeons' satisfaction with the training program and decrease the puncture times, fluoroscopy times, exposure time, and radiation dose significantly (P<0.001).

Conclusion

Isocentric navigation contributes to the training of PETD and may improve its standardization, homogenization, and generalization.

Learning curves of percutaneous endoscopic lumbar discectomy in transforaminal approach at the L4/5 and L5/S1 levels: a comparative study

OBJECTIVES

This study aimed to compare the learning curves of percutaneous endoscopic lumbar discectomy (PELD) in a transforaminal approach at the L4/5 and L5/S1 levels.

METHODS

We retrospectively reviewed the first 60 cases at the L4/5 level (Group I) and the first 60 cases at the L5/S1 level (Group II) of PELD performed by one spine surgeon. The patients were divided into subgroups A, B, and C (Group I: A cases 1-20, B cases 21-40, C cases 41-60; Group II: A cases 1-20, B cases 21-40, C cases 41-60). Operation time was thoroughly analyzed.

RESULTS

Compared with the L4/5 level, the learning curve of transforaminal PELD at the L5/S1 level was flatter. The mean operation times of Groups IA, IB, and IC were (88.75±17.02), (67.75±6.16), and (64.85±7.82) min, respectively. There was a significant difference between Groups A and B (P<0.05), but no significant difference between Groups B and C (P=0.20). The mean operation times of Groups IIA, IIB, and IIC were (117.25±13.62), (109.50±11.20), and (92.15±11.94) min, respectively. There was no significant difference between Groups A and B (P=0.06), but there was a significant difference between Groups B and C (P<0.05). There were 6 cases of postoperative dysesthesia (POD) in Group I and 2 cases in Group IIA (P=0.27). There were 2 cases of residual disc in Group I, and 4 cases in Group II (P=0.67). There were 3 cases of recurrence in Group I, and 2 cases in Group II (P>0.05).

CONCLUSIONS

Compared with the L5/S1 level, the learning curve of PELD in a transforaminal approach at the L4/5 level was steeper, suggesting that the L4/5 level might be easier to master after short-term professional training.

Navigation improves the learning curve of transforamimal percutaneous endoscopic lumbar discectomy

PURPOSE

Beginners usually need increased punctures and dozens of fluoroscopy in learning transforamimal percutaneous endoscopic lumbar discectomy (tPELD). Navigator-assisted spinal surgery (NASS) is a novel technique that could induce a definite trajectory. The retrospective study aimed to investigate the impact of a definite trajectory on the learning curve of tPELD.

METHODS

A total of 120 patients with symptomatic lumbar disc herniation who received tPELD between 2012 and 2014. Patients receiving tPELD with NASS technique by one surgeon were regarded as group A, and those receiving conventional methods by another surgeon were regarded as group B. Each group was divided into three subgroups (case 1-20, case 21-40, case 41-60).

RESULTS

The fluoroscopy times were 22.62 ± 3.80 in group A and 34.32 ± 4.78 in group B (P < 0.001). The pre-operative location time was 3.56 ± 0.60 minutes in group A and 5.49 ± 1.48 minutes in group B (P < 0.001). The puncture-channel time was 21.85 ± 4.31 minutes in group A and 34.20 ± 8.88 minutes in group B (P < 0.001). The operation time was 84.62 ± 9.20 minutes in group A and 101.97 ± 14.92 minutes in group B (P < 0.001), and the learning curve of tPELD in group A was steeper than that in group B. No significant differences were detected in patient-reported outcomes, hospital stay, patient satisfaction, and complication rate between the two groups (p > 0.05).

CONCLUSIONS

Definite trajectory significantly reduced the operation time, preoperative location time, puncture-channel time, and fluoroscopy times of tPELD by beginners, and thus reshaped the learning curve of tPELD and minimized the radiation exposure.