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Specialty Bias When Comparing Orthopaedic and Neurosurgery Trained Spine Surgeons: A Systematic Review and
Daniel Farivar1, Sang D Kim, Alexander Tuchman
1From the Department of Orthopaedic Surgery, Cedars-Sinai Medical Center (Farivar, Kim, Finkel, Nilssen, and D.L. Skaggs), the Department of Neurosurgery, Cedars-Sinai Medical Center, Los Angeles, CA (Tuchman), and the Department of Orthopaedic Surgery, Stanford University Hospital, Stanford, CA (K.F. Skaggs).
Introduction:
Comparisons made between spine-trained neurosurgeons (Neuro) and orthopaedic surgeons (Ortho) can be a delicate matter. Considering most authors are spine surgeons, one may wonder if study results inappropriately favor authors' own specialties. The purpose of this study was to perform a bibliometric analysis of all studies comparing spine surgeons of each training pathway and to evaluate potential biases when reporting study results.
Methods:
A systematic review was conducted according to the PRISMA statement. All literature comparing Neuro and Ortho before 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 from the total author list, 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 postoperative outcomes, categorizing the articles' stated conclusions (Pro-Neuro, Pro-Ortho, Neutral). Student t -test and Chi-squared analyses were used when appropriate to test for significance. Alpha level was set at <0.05.
Results:
A total of 80 studies were identified. Overall, 26 Neuro-Neuro articles, 34 Ortho-Ortho articles, and 20 Author Diverse articles were included. Neuro-Neuro authors were found to publish more in Neuro Journals ( P < 0.001). No differences were observed for inclusion of both Neuro and Ortho authors between studies published by the three different author types. Overall, there were 22 articles comparing postoperative outcomes: 15 articles (68%) reported no notable differences, whereas 3 (14%) found improved outcomes with Neuro, and 4 (18%) found improved outcomes with Ortho. No notable differences were found in outcomes when analyzed according to author type ( P = 0.531), journal type ( P = 0.962), and database used ( P = 0.636).
Conclusions:
The growing body of literature comparing Neuro and Ortho spine surgeons shows little differences in surgical outcomes and no evidence of bias.
Level Of Evidence:
V.
