ReviewJournal of spine surgery (Hong Kong)2026
High rates of spin bias in systematic reviews regarding anterior cervical discectomy and fusion
Review in Journal of spine surgery (Hong Kong), 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
What it found
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
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Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
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0 citing papers in PubMed.
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Authors and funding
9 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
Background: Surgical management for cervical degenerative disc disease includes anterior cervical discectomy and fusion (ACDF-the gold standard) and posterior cervical foraminotomy (PCF); however, current literature remains conflicted over the superiority of one procedure. Systematic reviews allow for comprehensive synthesis of literature but are susceptible to spin bias that may skew results and affect clinical decision making. This study aimed to evaluate the presence and number of spin bias in systematic reviews and meta-analyses comparing ACDF and PCF. To evaluate the prevalence, type, and predictors of spin bias in systematic reviews and meta-analyses comparing anterior cervical discectomy and fusion (ACDF) and PCF. Methods: A systematic search was conducted on PubMed, Web of Science, Embase, and Scopus for systematic reviews and meta-analyses comparing ACDF and PCF in June 2025. Articles were included if they were systematic reviews with or without meta-analysis, discussed treatment with surgical intervention, compared outcomes between ACDF and PCF, were available in English, and had the full text available. Any articles that did not follow these criteria were excluded. Included articles were assessed for the 9 most severe types of spin bias established by Yavchitz Results: Spin bias was found in 11 of 12 (92%) included articles, with number of different types of bias ranging from 0 to 2. Type 9 was the most common type of spin in 5 of 12 (42%) articles. Type 5 spin was found in 4 (33%) articles, Type 3 in 3 (25%) articles, Type 1 in 2 (16%) articles, and Types 2 and 4 in 1 (8%) article each. AMSTAR-2 quality assessments rated 7 of 12 (58%) articles as "critically low", and 5 of 12 (42%) as "low"; none received a "high" quality rating. Conclusions: Spin bias is highly prevalent (92%) in systematic reviews and meta-analyses comparing ACDF and PCF, with a maximum of 2 types of spin per article. All studies received either "critically low" or "low" quality ratings according to AMSTAR-2 criteria. Notably, all studies rated as "critically low" quality had at least 1 type of spin bias. Efforts and strategies to mitigate spin bias in orthopaedic literature are imperative to collectively enhance published literature.
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