Top 100 Most Frequently Cited Articles in Spine

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The most frequently cited articles on spinal disorders are guidelines on lumbar spinal pathology, including low back pain, and laboratory investigations into spinal biomechanics, according to an analysis of the top 100 cited articles in spine-specific journals. In contrast, a gap in research on neck pain and cervical spinal pathology was found, researchers reported in the December 15 issue of Spine.
Man holding several magazines.Over the last 20 years, spine specialists have considered frequently cited articles and guidelines on spinal disorders. Photo Source:“The study provides a snapshot of the top 100 most frequently cited articles related to spine over the last 20 years and highlights the most common areas of concentration as well as gaps in the literature,” said senior author Michael G. Fehlings, Professor of Neurosurgery and Co-Director of the Spine Program at the University of Toronto in Ontario, and Chair of the AOSpine International Spinal Cord Injury Knowledge Forum.

The top 5 most commonly cited articles in spine are shown in Table 1, and the top 5 most common areas of interest are shown in Table 2. The majority of articles were published in Spine (84), followed by European Spine Journal (7), and Journal of Spinal Disorders (3). The number of citations per articles ranged from 343 to 1949 (median, 453), and most works were published between 1990 and 2004.
Table 1. Top 5 Most Commonly Cited Articles in Spine Journals.Table 1. Top 5 Most Commonly Cited Articles in Spine Journals.
Table 2. Top 5 Most Cited Areas of Interest.Table 2. Top 5 Most Cited Areas of Interest.
“A caveat with this type of a study is that in order for an article to be cited frequently, it needs to be in the literature for 10 to 20 years; thus, there is a lag in terms of when the next round of highly cited articles will be,” Dr. Fehlings told SpineUniverse. “The study reflects the areas of intense research in the 90s and early 2000s.”

The patterns in areas of interest may be related to the development of technologies in spine instrumentation as well as the prevalence of low back pain disorders, Dr. Fehlings commented.

“The big breakthrough that occurred in late 80s early 90s was pedicle screw instrumentation, which has had a transformative effect on our ability to treat complex lumbar and thoracic disorders,” Dr. Fehlings said. In addition, “a number of operative vs non-operative types of studies aimed at trying to find best care pathways for patients with lumbar degenerative disorders have been published.”

Recent Guidelines on Cervical Myelopathy May Become Highly Cited

“I do anticipate that if this study is repeated in 10 years, we will see an increase in the number of important papers related to cervical spine pathology,” Dr. Fehlings explained. “In particular, there have been randomized trials on cervical arthroplasty, and I suspect that those will become highly cited. Also, I anticipate that some of the large prospective trials on cervical myelopathy, including those from the AOSpine group,1,2 will likely be highly cited as will some of the guidelines on cervical myelopathy from the AOSpine group.”

More Prospective Cohort and Randomized Trials Are Needed

The most common study design found in the paper was laboratory investigation, followed by guideline/recommendation (11), review (10), retrospective cohort study (10), systematic review/meta-analysis (8), and randomized controlled trial (8).

“The literature review highlights the need for high quality prospective cohort studies or randomized trials in the area of spine,” Dr. Fehlings said. “There are an increasing number of such trials being conducted, but certainly the impact of prospective comparative effectiveness or prospective randomized trials becomes clear when you see how often these articles are cited and how they potentially influence care.”

“One of the key messages from our paper is the importance of clinicians and researchers to undertake these types of high-quality studies,” Dr. Fehlings concluded.

Dr. Fehlings has no relevant disclosures.

Updated on: 12/20/18
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Michael G. Fehlings, MD, PhD, FRCSC, FACS
Professor of Neurosurgery
Vice Chair Research
Department of Surgery
University of Toronto

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