The Top 100 Most Cited Articles on Posterior Cervical Foraminotomies: A Bibliometric Analysis

Posterior cervical foraminotomy (PCF) is a procedure used for treating refractory cervical radiculopathy. Although anterior cervical discectomy and fusion (ACDF) remains the historical standard, growing evidence supports the noninferiority of PCF while preserving physiological cervical stability. While ACDF has extensive publications and associated bibliometric analyses, similar analyses are nonexistent for PCF. This study aims to identify the most influential studies related to PCF and investigate emerging trends and themes in the field.

The 100 most-cited articles related to PCF were identified through Web of Science. Title, publication year, journal, authorship, affiliation, country, and citation count were extracted. Keyword co-occurrence and co-authorship network analyses were performed using VOSviewer and Bibliometrix in RStudio.

The earliest article among the top 100 was published in 1990, with publications steadily increasing after. The most-cited article was Ruetten et al.'s 2008 article describing the efficacy of full-endoscopic PCF relative to ACDF for cervical disc herniations. Fessler R.G. was the most productive author, World Neurosurgery the most productive journal, and Seoul National University the most productive institution. The United States contributed the most articles (47), followed by South Korea (24), and then China (14). Network analysis identified comparative outcomes (ACDF versus PCF), minimally invasive surgery, and surgical technique as prevalent themes. Furthermore, small collaboration groups were observed with limited collaboration between groups.

This work analyzes the most influential papers related to PCF and demonstrates its continued advancement, especially with the emergence of minimally invasive techniques and trials demonstrating its efficacy compared to ACDF.