Introduction: Comparisons made between neurosurgery (Neuro) and orthopedic surgery (Ortho) trained spine surgeons can be a delicate matter. Considering most authors in this area are spine surgeons, one may wonder if study results inappropriately favor authors’ own specialties. The purpose of this study was to perform a (1) bibliometric analysis of all studies comparing spine surgeons of the two training pathways and to (2) evaluate potential biases when reporting study results.
Methods: All literature comparing Neuro and Ortho spine surgeons prior to May 2022 were identified. Included articles were categorized according to the training backgrounds of the first and last authors (“Neuro-Neuro,” “Ortho-Ortho,” or “Author Diverse”), evaluated for inclusion of both Neuro and Ortho authors, and classified by journal type of publication (“Neuro Journal,” “Ortho Journal,” or “Combined Journal”). A Neuro and Ortho spine surgeon each independently reviewed a subset of articles evaluating post-operative outcomes, categorizing the articles’ stated results (Pro-Neuro, Pro-Ortho, Mixed, Neutral) and conclusions (Pro-Neuro, Pro-Ortho, Neutral). Student’s T-test, Chi-squared analyses, and Linear regression analyses were used when appropriate to test for significance. Alpha < 0.05.
Results: A total of 80 studies were identified. There were 26 Neuro-Neuro articles, 34 Ortho-Ortho articles, and 20 Author Diverse articles. Neuro-Neuro authors were found to publish significantly more in Neuro Journals (P < 0.001). No significant differences were observed for inclusion of both Neuro and Ortho authors between studies published by the three different author types. There were 22 articles that compared post-operative outcomes: 14 (64%) papers reported no significant differences, while 3 (14%) found improved outcomes with Neuro spine surgeons, and 4 (18%) found improved outcomes with Ortho spine surgeons. There were no significant differences in outcomes when analyzed according to author type (P=0.531), journal type (P=0.962), and database used (P=0.636).
Conclusion : Despite clear differences in training pathways, the growing body of literature comparing Neuro and Ortho spine surgeons shows little differences in post-operative outcomes and no evidence of bias. Moving forward, efforts should be refocused from comparing the two subspecialties to instead finding ways to integrate the two and fostering collaboration at spine centers internationally.
