Asia Now Surpasses Europe in Spine Research Productivity An Analysis From 1976-2020

Study Design. Bibliometric review. Objective. This study aims to understand the worldwide research productivity trends in spine-related research over the past five decades. Summary of Background Data. Research productivity in the field of spine surgery has increased tremendously over the past decades. However, knowledge regarding the detailed regional disparity is limited. Methods. We evaluated original research articles published in four prestigious journals on spine research (European Spine Journal, Journal of Neurosurgery: Spine, Spine, and The Spine Journal) from 1976 to 2020. For 1 year of each decade, the origin of the first and the senior author was assigned to their region of origin. For the year 2020, a detailed analysis of countries and states of origin was performed, and the number of articles was normalized by registered MDs per country (per 10,000 population). Results. We included a total of 4436 articles and 8776 authors for analysis. From 1976 to 2020, the percentage of publications originating from North America decreased (77%-38%). In contrast, Asian contributions drastically increased (3%-36%), whereas articles originating from Europe only slightly raised (20%-22%). In 2020, the United States was the most productive country worldwide (34% with most articles from New York (19%), followed by China (16%) and Japan (10%). After normalization to registered MDs (per 10,000 population), the United States proved to have the highest number of articles. Besides this, India now ranked fourth and Egypt eighth in terms of the most productive countries per MDs. Conclusion. North America contributed the largest share of all articles published in the last five decades. Asia, which ranks second in 2020, has overtaken Europe. Normalization to registered MDs can be a helpful tool to reflect a country's research productivity more accurately.