Growing Trend of the Arab Surgeons' Contribution in Spine Surgery: A Systemic Review of the Top-Ranked Spine Journals
Authors: Siam Ahmed Ezzat , Gouda-Mohamed Gouda-Mohamed , Shawky Ahmed 
Published: April 2016

Introduction Spine surgery is a very rapidly developing subspecialty worldwide. Although through history, Arab surgeons have made valuable contributions to medicine and surgery, the quantity and quality of modern research production of the Arab spine surgeons is unclear. This study aimed to investigate the contribution of the Arab surgeons to this field. Methods A systemic review of the PubMed/Medline including the top 5 spine journals: Spine, The Spine Journal (TSJ), European Spine Journal (ESJ), Journal of Neurosurgery; Spine (JNS) and Journal of Spinal Disorders and Techniques (its older version Journal of Spinal Disorders, as well) (JSD). Articles published before the end of July 2015 have been included. At least one affiliation or one author must be based in one of the 22 Arab countries. Analysis of the number of articles published from each country, type of study, institution, impact factor (JCR 2014) and trend of publications frequency over years. The quality of research publications was assessed by number of citations and level of evidence (of clinical studies). Number of publications of the Arab World will be compared with those of other top countries, who contributed to these 5 journals over time, as well as rate of publication in relation to every one million inhabitants. Results The review revealed 175 articles; Spine 81, TSJ 24, ESJ 49, JNS 9 and JSD 12 articles. Most frequently clinical studies (90 articles, 51%). Most publications originated from the university: 199 articles (68%). Egyptian authors published 58, Lebanese 36, Saudis 27 articles. Egyptian authors mainly published retrospective studies (26, 45%) and prospective uncontrolled studies (17, 29%). Those from Lebanon published 14 case reports (39%) and 13 retrospective studies (36%). Saudi affiliations similarly published 8 case reports (30%) and 6 retrospective studies (22%). Moroccan and Tunisian publications were mainly case reports; 14 (78%) and 7 (54%), respectively. Institutionally, Cairo University published the highest number of articles; 24, followed by the American University in Beirut 23 and University of Alexandria with 20 Articles. A mean of 2.86 citations/article of all publications has been calculated. Articles published in Spine had the highest citation rate: 3.85, followed by those of ESJ: 2.71 citations/article. According to study type, clinical studies were most frequently cited with a mean of 4.5 citations/article. Of these, studies with LOE I had a mean of 8.33 citations/article. Publications from non-surgical departments had a higher citation rate than surgical departments. Although Kuwait-based authors published only 4 articles, they have the highest rate of citation per article: 6, followed by Lebanon: 4.33, Saudi Arabia: 3.89 and Egypt: 2.62. As well, Kuwait City and Jeddah were the cities on the top with a mean of 6 citations/article. Conclusion Over three decades, there has been a continuous increase in frequency of publication. Despite this increase, the relation of this contribution to the global contribution to these 5 journals did not change since the first publication in 1986. Systematic institutional and national policies and measures should be taken to improve this contribution.