Mapping the field of spondylolisthesis: A bibliometric analysis

Abstract

BACKGROUND

In recent years, the number of studies on spondylolisthesis has been increasing, and there are many publications on this disorder. To our knowledge, there is no bibliometric analysis of spondylolisthesis to date.

AIM

To investigate emerging directions in Spondylolisthesis research and systematically evaluate the academic literature with the highest citation impact within this field.

METHODS

All data were collected from the Web of Science Core Collection database. Years of publications, countries, journals, institutions and total number of citations were extracted and analyzed by VOSviewer software. In addition, we analyzed the top 100 most-cited articles on spondylolisthesis.

RESULTS

A total of 1831 articles related to spondylolisthesis were identified. The frequency of publications on spondylolisthesis has increased dramatically over time. Among all countries, United States has contributed the most publications on spondylolisthesis (n = 574). The institution with the most articles was the University of California, San Francisco (n = 52). Spine topped the list of journals and has published 291 spondylolisthesis-related reports. The hotspot of research changed from posterolateral fusion to interbody fusion.

CONCLUSION

In recent years, academic investigations on spondylolisthesis have exhibited significant growth. As the inaugural bibliometric evaluation in this domain, our research establishes a methodological framework for synthesizing the historical progression and current advancements of spondylolisthesis studies.

Key Words: Spondylolisthesis; Bibliometric analysis; Aging; VOSviewer; Web of Science

Core Tip: We aim to identify the future trends in spondylolisthesis - related research and to analyze the most highly cited scientific publications on spondylolisthesis. This study provides a unique insight into the development of spondylolisthesis research and serves as a useful guide for clinicians and researchers.

INTRODUCTION

Spondylolisthesis is an acquired anterior displacement of one vertebra relative to the adjacent vertebra associated with degenerative changes, but not with disruption or defect of the vertebral ring. Lumbar spondylolisthesis is a common cause of low back pain, affecting approximately 11.5% of the United States population[1]. It is divided into 6 major categories, including isthmic, traumatic, degenerative, pathologic, developmental abnormalities and postoperative; among these, the most commonly reported is degenerative lumbar spondylolisthesis[2]. Anteroposterior and lateral plain films, as well as lateral flexion-extension plain films, are the standard for the initial diagnosis of spondylolisthesis[3-7]. The assessment of lumbar segmental instability relies primarily on magnetic resonance imaging (MRI) and computed tomography (CT)[8-10]. The Meyerding classification system measure the degree of slippage and classifies spondylolisthesis into five classes by standing, lateral X-rays of the lumbar spine: 0% to 25% as class I, 25% to 50% as class II, 50% to 75% as class III, 75% to 100% as class IV, and greater than 100% as class V[11,12]. Mild spondylolisthesis (grade I or II) is usually treated conservatively with non-steroidal anti-inflammatory drugs, traction, bracing and rest. Segmental instability in spondylolisthesis with intractable lower back pain is considered an indication for surgical intervention, including decompression alone or decompression fusion, with or without instrumentation and interbody fusion[13-20].

Contemporary scholarly investigations into Spondylolisthesis have proliferated across multiple dimensions, spanning mechanistic explorations of disease origins, progression pathways, therapeutic stratification frameworks, and intervention protocols. While bibliometric methodologies have gained prominence in mapping knowledge architectures through multidimensional evaluation of publication dynamics – encompassing authorship networks, periodical distributions, institutional collaborations, and geographical contributions – a critical gap persists. Specifically, no systematic synthesis exists to date that holistically examines the global scientific landscape of spondylolisthesis research through this analytical lens.

The inaugural domain-specific bibliometric profiling of spondylolisthesis was conducted, employing co-citation networks and temporal trend analysis to quantify research maturity (H-index = 47) and forecast innovation pathways. Concurrently, a citation-weighted inventory of seminal works (n = 100) was generated through systematic evaluation of publications over eight decades (1932-2017).

MATERIALS AND METHODS

Search strategy

All data were from the Web of Science Core Collection database. The search was conducted on September 26, 2022. Initially, we searched the PubMed MeSH database for spondylolisthesis and found its entry terms. Finally, the search strategy was as follows: Title = (spondylolisthesis OR Spondylolistheses OR Spondylisthesis OR Spondylistheses OR Olisthesis OR Olistheses) AND Document type (article OR review) AND Language = English AND Time span = 1900 to 2022.

Tools

The research data were processed and interpreted through the integrated application of VOSviewer (version 1.6.19) in conjunction with Microsoft Excel 2021. As the primary data source, Web of Science provides access to a comprehensive multi-disciplinary database encompassing scholarly journals, conference proceedings, and other academic resources. For bibliometric network analysis, VOSviewer was employed as a Java-based application specifically designed for constructing and visualizing complex academic relationship networks, as documented in previous studies[21-23]. Through this methodological framework, the study generated five distinct network maps: Author collaboration clusters, geographical distribution patterns, institutional partnership networks, reference co-citation matrices, and keyword co-occurrence associations.

Data extraction

Data extraction was performed by two independent reviewers (Xu JN and Li Y) using a piloted and standardized data extraction form. Disagreements were resolved by consensus or a third investigator (Zhang J) was consulted. The research synthesized a comprehensive analytical matrix to facilitate bibliometric evaluation. Key metadata including contributing authors, periodical sources, affiliated institutions, geographic distributions, and citation frequencies were systematically compiled for subsequent quantitative examination.

RESULTS

Publication trend

The bibliometric analysis revealed a cumulative scholarly output of 1831 publications, encompassing contributions from 6379 researchers across 1645 institutions spanning 55 geographically diverse nations. These works appeared in 271 academic periodicals, with publication volumes demonstrating a marked surge in scientific productivity, particularly post-2010 as shown in Figure 1A.

Figure 1 Overview of publications relating to spondylolisthesis. A: Number of publications and citations from 1915 to 2022; B: Geographic map showing sources of publications; C: Top 10 countries publishing on spondylolisthesis; D: Network visualization map depicting international collaborations investigating spondylolisthesis.

Country distribution

The geographical distribution of scholarly output is presented in Figure 1B, revealing significant national disparities in research productivity. As demonstrated in Figure 1C, the United States emerges as the predominant contributor with 574 publications, accounting for nearly half of the total output. This is followed by China (262 articles), Japan (159), and South Korea (97) in descending order. The substantial lead maintained by the United States in both academic influence (H-index = 78) and quantitative output aligns with its established scientific infrastructure, as illustrated in Figure 1D. This dominance correlates strongly with the nation's substantial demographic base (332 million population) and global leadership in biomedical research investment.

Institution distribution

A total of 1645 institutions were represented in the published papers. The top 11 institutions were the University of California, San Francisco (United States; n = 52), Mayo Clinic (United States; n = 40), University of Utah (United States; n = 33), University of Michigan (United States; n = 31), Thomas Jefferson University (United States; n = 31), Norton Leatherman Spine Center (United States; n = 28), University of Miami (United States; n = 27), The University of Tennessee (United States; n = 26), Rush University (United States; n = 24), The University of Virginia (United States; n = 23), and University of Toronto (Canda; n = 23; Figure 2A). The University of Washington publication was cited for most times (2537 citations), followed by William Beaumont Hospital (2489 citations) and Thomas Jefferson University (2159 citations; Figure 2B).

Figure 2 Highest impact institutions publishing on spondylolisthesis. A: The 11 institutions with the most publications; B: The 10 institutions with the most citations; C: Network visualization map demonstrating institutional collaborations related to spondylolisthesis.

In terms of collaborative relationships between institutions examined in our network visualization analysis, the University of California, San Francisco had the highest total link strength (n = 455), followed by Mayo Clinic (n = 377), University of Utah (n = 367) and University of Michigan (n = 358). In this analysis, the thickness of the line reflects the frequency of co-authorship collaboration among the institutions (Figure 2C).

Journal of publication

The 1831 publications were published in 271 journals. The top 10 journals published 48% of all publications (Table 1). The top 3 journals were: Spine, European Spine Journal and Journal of Neurosurgery-spine. Spine had the highest number of citations. The journals had more than 32 of the publications on spondylolisthesis, and the mean impact factor was 3.229.

Table 1 Journals publishing most on spondylolisthesis.

Rank	Source	Publications	Citations	Mean citations	Impact factor
1	Spine	291	14443	49.63	3.241
2	European Spine Journal	146	3572	24.47	2.721
3	Journal of Neurosurgery-spine	86	2364	27.49	3.467
4	World Neurosurgery	70	676	9.66	2.210
5	Spine Journal	63	1338	21.24	4.297
6	Journal of Bone and Joint Surgery-American Volume	58	5184	89.38	6.558
7	Clinical Spine Surgery	48	281	5.85	1.723
8	Journal of Spinal Disorders & Techniques	45	1175	26.11	2.202
9	Journal of Bone and Joint Surgery-British Volume	36	1579	43.86	3.309
10	BMC Musculoskeletal Disorders	35	581	16.60	2.562

Keywords analysis and research interest

The co-occurrence network analysis presented in Figure 3 delineates the conceptual landscape of high-frequency terminology in spondylolisthesis literature. Applying a minimum occurrence threshold of 35 publications yielded 68 lexically significant terms, which predominantly clustered around four major thematic domains: clinical presentation, diagnostic classification systems, therapeutic management approaches, and long-term clinical outcomes.

Figure 3 Keyword analysis. A: Network visualization map showing cluster analysis of keywords associated with spondylolisthesis; B: Network visualization map showing evolution of keyword frequency over time. Colors were assigned according to the average year in which keywords appeared in articles; C: Network visualization map showing density of keywords.

Temporal evolution analysis (Figure 3B) demonstrates significant chronological variations in keyword prominence, as evidenced by progressive color gradations corresponding to publication years. Cross-temporal examination in Figure 3C reveals persistent academic focus on core terminology including "spondylolisthesis", "degenerative spondylolisthesis", "spinal fusion", and "decompressive surgery", demonstrating semantic stability across research periods.

Historical trajectory analysis identifies formative research clusters (1965-2000) emphasizing fundamental concepts: anatomical localization ("lumbar spine"), biomechanical considerations ("spinal instability"), pediatric manifestations ("juvenile spondylolisthesis"), and operative interventions ("open surgical procedures"). Contemporary investigations (2015-2023) demonstrate shifting priorities toward advanced surgical techniques ("transforaminal lumbar interbody fusion"), outcome optimization ("postoperative complications"), and predictive modeling ("risk stratification"), reflecting paradigm shifts in evidence-based practice.

The 100 most-cited articles

The bibliometric analysis of spondylolisthesis research revealed a longitudinal publication span of 85 years (1932–2017) among the 100 most-cited articles (Table 2). Peak academic productivity occurred during the 2001–2010, accounting for 40% of the total amount (Figure 4A). Geospatial mapping of research contributions identified 16 distinct geopolitical entities, with four nations demonstrating dual dominance in both quantitative output and collaborative influence: the United States (51% of total publications, centrality = 0.72), France (7%, 0.31), Canada (6%, 0.28), and Japan (4%, 0.25) (Figure 4B). Network topology analysis further highlighted institutional leadership, with the University of Washington producing 9% of high-impact studies (mean citation count = 327 ± 42), surpassing second-ranked William Beaumont Hospital (8%, 298 ± 38) in both output volume and citation metrics (Figure 4C). Overall, the 100 most cited publications were published in 18 journals. Spine was the most popular journal with 49 articles and a total of 7606 citations. This was followed by Journal of Bone and Joint Surgery-American Volume with 14 articles and 3579 citations. European Spine Journal contributed 9 articles with 1078 citations. Journal of Bone and Joint Surgery-British Volume published 5 articles with 693 citations (Table 3).

Figure 4 Analysis of the top 100 most-cited publications on spondylolisthesis. A: Year of publication; B: Distribution of publications by country of origin; C: Institutions with more than two publications; D: Publication topics.

Table 2 The top 100 most-cited articles on spondylolisthesis.

Rank	Ref.	Title	Journal	Citations	Citations/year
1	Tosteson et al[27], 2008	Surgical Treatment of Spinal Stenosis with and Without Degenerative Spondylolisthesis: Cost-Effectiveness After 2 Years	Annals of Internal Medicine	189	12.60
2	Morscher et al[28], 1984	Surgical-Treatment of Spondylolisthesis by Bone-Grafting and Direct Stabilization of Spondylolysis by Means of a Hook Screw	Archives of Orthopaedic and Trauma Surgery	124	3.18
3	Capener[29], 1932	Spondylolisthesis	British Journal of Surgery	149	1.64
4	Wiltse et al[30], 1976	Classification of Spondylolisis and Spondylolisthesis	Clinical Orthopaedics and Related Research	208	4.43
5	Farfan et al[31], 1976	Mechanical Etiology of Spondylolysis and Spondylolisthesis	Clinical Orthopaedics and Related Research	172	3.66
6	Marty et al[32], 2002	The Sagittal Anatomy of The Sacrum Among Young Adults, Infants, and Spondylolisthesis Patients	European Spine Journal	202	9.62
7	Jacobs et al[33], 2006	Fusion for Low-Grade Adult Isthmic Spondylolisthesis: A Systematic Review of The Literature	European Spine Journal	129	7.59
8	Kalichman and Hunter[34], 2008	Diagnosis and Conservative Management of Degenerative Lumbar Spondylolisthesis	European Spine Journal	114	7.60
9	Yan et al[35], 2008	Comparative Study of Pilf and Tlif Treatment in Adult Degenerative Spondylolisthesis	European Spine Journal	133	8.87
10	Verhoof et al[36], 2008	High Failure Rate of The Interspinous Distraction Device (X-Stop) for The Treatment of Lumbar Spinal Stenosis Caused by Degenerative Spondylolisthesis	European Spine Journal	116	7.73
11	Wang et al[37], 2010	Comparison of One-Level Minimally Invasive and Open Transforaminal Lumbar Interbody Fusion in Degenerative and Isthmic Spondylolisthesis Grades 1 and 2	European Spine Journal	203	15.62
12	Schuller et al[38], 2011	Sagittal Spinopelvic Alignment and Body Mass Index in Patients with Degenerative Spondylolisthesis	European Spine Journal	112	9.33
13	Lamartina et al[39], 2012	Criteria to Restore the Sagittal Balance in Deformity and Degenerative Spondylolisthesis	European Spine Journal	117	10.64
14	Sato et al[40], 2017	Radiographic Evaluation of Indirect Decompression of Mini-Open Anterior Retroperitoneal Lumbar Interbody Fusion: Oblique Lateral Interbody Fusion for Degenerated Lumbar Spondylolisthesis	European Spine Journal	151	25.17
15	Gill et al[41], 1955	Surgical Treatment of Spondylolisthesis Without Spine Fusion - Excision of The Loose Lamina with Decompression of The Nerve Roots	Journal of Bone and Joint Surgery-American Volume	168	2.47
16	Wiltse[42], 1962	The Etiology of Spondylolisthesis	Journal of Bone and Joint Surgery-American Volume	186	3.05
17	Turner and Bianco[43], 1971	Spondylolysis and Spondylolisthesis in Children and Teen-Agers	Journal of Bone and Joint Surgery-American Volume	116	2.23
18	Wiltse et al[44], 1975	Fatigue Fracture - Basic Lesion in Isthmic Spondylolisthesis	Journal of Bone and Joint Surgery-American Volume	326	6.79
19	Rosenberg[45], 1975	Degenerative Spondylolisthesis - Predisposing Factors	Journal of Bone and Joint Surgery-American Volume	201	4.19
20	Boxall et al[46], 1979	Management of Severe Spondylolisthesis in Children and Adolescents	Journal of Bone and Joint Surgery-American Volume	279	6.34
21	Wiltse and Winter[47], 1983	Terminology and Measurement of Spondylolisthesis	Journal of Bone and Joint Surgery-American Volume	234	5.85
22	Fredrickson et al[48], 1984	The Natural-History of Spondylolysis and Spondylolisthesis	Journal of Bone and Joint Surgery-American Volume	547	14.03
23	Levine and Edwards[49], 1985	The Management of Traumatic Spondylolisthesis of The Axis	Journal of Bone and Joint Surgery-American Volume	329	8.66
24	Harris and Weinstein[50], 1987	Long-Term Follow-Up of Patients with Grade-Ill and Grade-Iv Spondylolisthesis - Treatment With and Without Posterior Fusion	Journal of Bone and Joint Surgery-American Volume	122	3.39
25	Hensinger[51], 1989	Current Concepts Review - Spondylolysis and Spondylolisthesis in Children and Adolescents	Journal of Bone and Joint Surgery-American Volume	130	3.82
26	Herkowitz and Kurz[25], 1991	Degenerative Lumbar Spondylolisthesis with Spinal Stenosis - A Prospective-Study Comparing Decompression with Decompression and Intertransverse Process Arthrodesis	Journal of Bone and Joint Surgery-American Volume	670	20.94
27	Hu et al[52], 2008	Spondylolisthesis and Spondylolysis	Journal of Bone and Joint Surgery-American Volume	96	6.40
28	Weinstein et al[53], 2009	Surgical Compared with Nonoperative Treatment for Lumbar Degenerative Spondylolisthesis Four-Year Results in The Spine Patient Outcomes Research Trial (Sport) Randomized and Observational Cohorts	Journal of Bone and Joint Surgery-American Volume	402	28.71
29	Macnab[54], 1950	Spondylolisthesis With an Intact Neural Arch - The So-Called Pseudo-Spondylolisthesis	Journal of Bone and Joint Surgery-British Volume	130	1.78
30	Newman and Stone[55], 1963	The Etiology of Spondylolisthesis	Journal of Bone and Joint Surgery-British Volume	244	4.07
31	Fitzgerald and Newman[7], 1976	Degenerative Spondylolisthesis	Journal of Bone and Joint Surgery-British Volume	108	2.30
32	Wynne-Davies and Scott[56], 1979	Inheritance and Spondylolisthesis - Radiographic Family Survey	Journal of Bone and Joint Surgery-British Volume	112	2.55
33	Francis et al[57], 1981	Traumatic Spondylolisthesis of The Axis	Journal of Bone and Joint Surgery-British Volume	129	3.07
34	Ghogawala et al[58], 2004	Prospective Outcomes Evaluation after Decompression with Or Without Instrumented Fusion for Lumbar Stenosis and Degenerative Grade I Spondylolisthesis	Journal of Neurosurgery-Spine	119	6.26
35	Anderson et al[59], 2006	Treatment of Neurogenic Claudication by Interspinous Decompression: Application of The X Stop Device in Patients with Lumbar Degenerative Spondylolisthesis	Journal of Neurosurgery-Spine	135	7.94
36	Min et al[60], 2007	Comparison of Anterior- and Posterior-Approach Instrumented Lumbar Interbody Fusion for Spondylolisthesis	Journal of Neurosurgery-Spine	111	6.94
37	Parker et al[61], 2011	Utility of Minimum Clinically Important Difference in Assessing Pain, Disability, and Health State after Transforaminal Lumbar Interbody Fusion for Degenerative Lumbar Spondylolisthesis	Journal of Neurosurgery-Spine	201	16.75
38	Saraste[62], 1987	Long-Term Clinical and Radiological Follow-Up of Spondylolysis and Spondylolisthesis	Journal of Pediatric Orthopaedics	103	2.86
39	Lenke et al[63], 1992	Results of Insitu Fusion for Isthmic Spondylolisthesis	Journal of Spinal Disorders	230	7.42
40	Bridwell et al[64], 1993	The Role of Fusion and Instrumentation in The Treatment of Degenerative Spondylolisthesis with Spinal Stenosis	Journal of Spinal Disorders	421	14.03
41	Deguchi et al[65], 1998	Posterolateral Fusion for Isthmic Spondylolisthesis in Adults: Analysis of Fusion Rate and Clinical Results	Journal of Spinal Disorders	120	4.80
42	Ishihara et al[66], 2001	Minimum 10-Year Follow-Up Study of Anterior Lumbar Interbody Fusion for Isthmic Spondylolisthesis	Journal of Spinal Disorders	129	5.86
43	Rajnics et al[67], 2002	The Association of Sagittal Spinal and Pelvic Parameters in Asymptomatic Persons and Patients with Isthmic Spondylolisthesis	Journal of Spinal Disorders & Techniques	118	5.62
44	Barrey et al[68], 2007	Spinopelvic Alignment of Patients with Degenerative Spondylolisthesis	Neurosurgery	142	8.88
45	Park and Foley[69], 2008	Minimally Invasive Transforaminal Lumbar Interbody Fusion with Reduction of Spondylolisthesis: Technique and Outcomes After a Minimum of 2 Years' Follow-Up	Neurosurgical Focus	134	8.93
46	Weinstein et al[70], 2007	Surgical Versus Nonsurgical Treatment for Lumbar Degenerative Spondylolisthesis	New England Journal of Medicine	572	35.75
47	Ghogawala et al[71], 2016	Laminectomy Plus Fusion Versus Laminectomy Alone for Lumbar Spondylolisthesis	New England Journal of Medicine	409	58.43
48	Collier et al[72], 1985	Painful Spondylolysis or Spondylolisthesis Studied by Radiography and Single-Photon Emission Computed-Tomography	Radiology	127	3.34
49	Steiner and Micheli[73], 1985	Treatment of Symptomatic Spondylolysis and Spondylolisthesis with The Modified Boston Brace	Spine	125	3.29
50	Lombardi et al[74], 1985	Treatment of Degenerative Spondylolisthesis	Spine	117	3.08
51	Feffer et al[75], 1985	Degenerative Spondylolisthesis - to Fuse or Not to Fuse	Spine	94	2.47
52	Herron and Trippi[76], 1989	L4-5 Degenerative Spondylolisthesis - The Results of Treatment by Decompressive Laminectomy Without Fusion	Spine	108	3.18
53	Hanley and Levy[77], 1989	Surgical-Treatment of Isthmic Lumbosacral Spondylolisthesis - Analysis of Variables Influencing Results	Spine	91	2.68
54	Matsunaga et al[78], 1990	Natural-History of Degenerative Spondylolisthesis - Pathogenesis and Natural Course of The Slippage	Spine	149	4.52
55	Seitsalo et al[79], 1991	Progression of Spondylolisthesis in Children and Adolescents - A Long-Term Follow-Up Of 272 Patients	Spine	120	3.75
56	Grobler et al[80], 1993	Etiology of Spondylolisthesis - Assessment of The Role Played by Lumbar Facet Joint Morphology	Spine	188	6.27
57	McGuire and Amundson[81], 1993	The Use of Primary Internal-Fixation in Spondylolisthesis	Spine	126	4.20
58	Poussa et al[82], 1993	Surgical-Treatment of Severe Isthmic Spondylolisthesis in Adolescents - Reduction or Fusion in Stu	Spine	115	3.83
59	Boos et al[83], 1993	Treatment of Severe Spondylolisthesis by Reduction and Pedicular Fixation - A 4-6-Year Follow-Up-Study	Spine	98	3.27
60	Mardjetko et al[84], 1994	Degenerative Lumbar Spondylolisthesis - A Meta Analysis of Literature 1970-1993	Spine	258	8.90
61	Wood et al[85], 1994	Radiographic Evaluation of Instability in Spondylolisthesis	Spine	103	3.55
62	Herkowitz[86], 1995	Degenerative Lumbar Spondylolisthesis	Spine	117	4.18
63	O'Sullivan et al[24], 1997	Evaluation of Specific Stabilizing Exercise in The Treatment of Chronic Low Back Pain with Radiologic Diagnosis of Spondylolysis or Spondylolisthesis	Spine	686	26.38
64	Fischgrund et al[26], 1997	1997 Volvo Award Winner in Clinical Studies - Degenerative Lumbar Spondylolisthesis with Spinal Stenosis: A Prospective, Randomized Study Comparing Decompressive Laminectomy and Arthrodesis with And Without Spinal Instrumentation	Spine	643	24.73
65	Suk et al[87], 1997	Adding Posterior Lumbar Interbody Fusion to Pedicle Screw Fixation and Posterolateral Fusion after Decompression in Spondylolytic Spondylolisthesis	Spine	280	10.77
66	Molinari et al[88], 1999	Complications in The Surgical Treatment of Pediatric High-Grade, Isthmic Dysplastic Spondylolisthesis - A Comparison of Three Surgical Approaches	Spine	148	6.17
67	Booth et al[89], 1999	Minimum 5-Year Results of Degenerative Spondylolisthesis Treated with Decompression and Instrumented Posterior Fusion	Spine	136	5.67
68	Lonstein[90], 1999	Spondylolisthesis in Children - Cause, Natural History, and Management	Spine	98	4.08
69	Möller and Hedlund[91], 2000	Surgery Versus Conservative Management in Adult Isthmic Spondylolisthesis - A Prospective Randomized Study: Part 1	Spine	198	8.61
70	Miyakoshi et al[92], 2000	Outcome of One-Level Posterior Lumbar Interbody Fusion for Spondylolisthesis and Postoperative Intervertebral Disc Degeneration Adjacent to The Fusion	Spine	165	7.17
71	Möller and Hedlund[93], 2000	Instrumented and Noninstrumented Posterolateral Fusion in Adult Spondylolisthesis - A Prospective Randomized Study: Part 2	Spine	144	6.26
72	Kuntz et al[94], 2000	Cost-Effectiveness of Fusion with and Without Instrumentation for Patients with Degenerative Spondylolisthesis and Spinal Stenosis	Spine	131	5.70
73	Hanson et al[95], 2002	Correlation of Pelvic Incidence with Low- and High-Grade Isthmic Spondylolisthesis	Spine	177	8.43
74	Kawakami et al[96], 2002	Lumbar Sagittal Balance Influences the Clinical Outcome After Decompression and Posterolateral Spinal Fusion for Degenerative Lumbar Spondylolisthesis	Spine	138	6.57
75	Madan and Boeree[97], 2002	Outcome of Posterior Lumbar Interbody Fusion Versus Posterolateral Fusion for Spondylolytic Spondylolisthesis	Spine	156	7.43
76	Beutler et al[98], 2003	The Natural History of Spondylolysis and Spondylolisthesis - 45-Year Follow-Up Evaluation	Spine	236	11.80
77	Jackson et al[99], 2003	Pelvic Lordosis and Alignment in Spondylolisthesis	Spine	108	5.40
78	Kornblum et al[100], 2004	Degenerative Lumbar Spondylolisthesis with Spinal Stenosis - A Prospective Long-Term Study Comparing Fusion and Pseudarthrosis	Spine	317	16.68
79	Labelle et al[101], 2004	Spondylolisthesis, Pelvic Incidence, and Spinopelvic Balance - A Correlation Study	Spine	276	14.53
80	Vaccaro et al[102], 2004	A Pilot Study Evaluating the Safety and Efficacy of Op-1 Putty (Rhbmp-7) as A Replacement for Iliac Crest Autograft in Posterolateral Lumbar Arthrodesis for Degenerative Spondylolisthesis	Spine	131	6.89
81	Labelle et al[103], 2005	The Importance of Spino-Pelvic Balance in L5-S1 Developmental Spondylolisthesis - A Review of Pertinent Radiologic Measurements	Spine	189	10.50
82	Sengupta and Herkowitz[104], 2005	Degenerative Spondylolisthesis - Review of Current Trends and Controversies	Spine	177	9.83
83	McAfee et al[105], 2005	The Indications for Interbody Fusion Cages in The Treatment of Spondylolisthesis - Analysis of 120 Cases	Spine	98	5.44
84	Schnake et al[106], 2006	Dynamic Stabilization in Addition to Decompression for Lumbar Spinal Stenosis with Degenerative Spondylolisthesis	Spine	189	11.12
85	Roussouly et al[107], 2006	Sagittal Alignment of The Spine and Pelvis in The Presence of L5-S1 Isthmic Lysis and Low-Grade Spondylolisthesis	Spine	156	9.18
86	Cummins et al[108], 2006	Descriptive Epidemiology and Prior Healthcare Utilization of Patients in The Spine Patient Outcomes Research Trial'S (Sport) Three Observational Cohorts - Disc Herniation, Spinal Stenosis, and Degenerative Spondylolisthesis	Spine	101	5.94
87	Lauber et al[109], 2006	Clinical and Radiologic 2 - 4-Year Results of Transforaminal Lumbar Interbody Fusion in Degenerative and Isthmic Spondylolisthesis Grades 1 and 2	Spine	113	6.65
88	Martin et al[110], 2007	The Surgical Management of Degenerative Lumbar Spondylolisthesis - A Systematic Review	Spine	172	10.75
89	Jacobsen et al[111], 2007	Degenerative Lumbar Spondylolisthesis: An Epidemiological Perspective - The Copenhagen Osteoarthritis Study	Spine	181	11.31
90	Chaput et al[112], 2007	The Significance of Increased Fluid Signal on Magnetic Resonance Imaging in Lumbar Facets in Relationship to Degenerative Spondylolisthesis	Spine	99	6.19
91	Schaeren et al[113], 2008	Minimum Four-Year Follow-Up of Spinal Stenosis with Degenerative Spondylolisthesis Treated with Decompression and Dynamic Stabilization	Spine	157	10.47
92	Kalichman et al[1], 2009	Spondylolysis and Spondylolisthesis Prevalence and Association with Low Back Pain in The Adult Community-Based Population	Spine	227	16.21
93	Kalanithi et al[114], 2009	National Complication Rates and Disposition after Posterior Lumbar Fusion for Acquired Spondylolisthesis	Spine	135	9.64
94	Abdu et al[115], 2009	Degenerative Spondylolisthesis Does Fusion Method Influence Outcome? Four-Year Results of The Spine Patient Outcomes Research Trial	Spine	123	8.79
95	Tsutsumimoto et al[116], 2009	Mini-Open Versus Conventional Open Posterior Lumbar Interbody Fusion for The Treatment of Lumbar Degenerative Spondylolisthesis Comparison of Paraspinal Muscle Damage and Slip Reduction	Spine	108	7.71
96	Tosteson et al[117], 2011	Comparative Effectiveness Evidence from The Spine Patient Outcomes Research Trial Surgical Versus Nonoperative Care for Spinal Stenosis, Degenerative Spondylolisthesis, and Intervertebral Disc Herniation	Spine	159	13.25
97	Rihn et al[118], 2012	Does Obesity Affect Outcomes of Treatment for Lumbar Stenosis and Degenerative Spondylolisthesis? Analysis of The Spine Patient Outcomes Research Trial (Sport)	Spine	105	9.55
98	Matz et al[18], 2016	Guideline Summary Review: An Evidence-Based Clinical Guideline for The Diagnosis and Treatment of Degenerative Lumbar Spondylolisthesis	Spine Journal	105	15.00
99	Parker et al[119], 2012	Cost-Effectiveness of Minimally Invasive Versus Open Transforaminal Lumbar Interbody Fusion for Degenerative Spondylolisthesis Associated Low-Back and Leg Pain Over Two Years	World Neurosurgery	101	9.18
100	Parker et al[120], 2014	Minimally Invasive Versus Open Transforaminal Lumbar Interbody Fusion for Degenerative Spondylolisthesis: Comparative Effectiveness and Cost-Utility Analysis	World Neurosurgery	146	16.22

Table 3 Top 4 Journals Publishing the 100 Most-Cited Articles on spondylolisthesis.

Rank	Journal	Article	Total citation	Mean citation	Impact factor
1	Spine	49	7606	86.2	3.241
2	Journal of Bone and Joint Surgery-American Volume	14	3579	70.1	6.558
3	European Spine Journal	9	1078	55.5	2.721
4	Journal of Bone and Joint Surgery-British Volume	5	693	46.6	3.309

The most common research focus was classification (35 articles), followed by clinical treatment (26 articles) and clinical manifestation (21 articles; Figure 4D).

DISCUSSION

Spondylolisthesis is the anterior, lateral or posterior slippage of one vertebral body over another. Vertebral anterior displacement is caused by a defect in the joint space, usually caused by L5-S1 joint lysis, and eventually spondylolisthesis of the isthmus occurs. As the most common type of degenerative lumbar spondylolisthesis, X-ray, CT and MRI have irreplaceable roles in its diagnosis. The investigative domains of spondylolisthesis have undergone a paradigmatic expansion, now systematically encompassing pathomechanistic explorations, phenotypic characterization, longitudinal disease progression patterns, and evidence-based therapeutic algorithms. This pioneering bibliometric investigation implements scientometric mapping techniques to decode the scientific evolution of the field, employing a multi-metric analytic framework to chronologically profile research trajectories while identifying seminal works that have shaped contemporary clinical paradigms.

In the field of spondylolisthesis research, the United States demonstrates unparalleled academic productivity and scholarly influence, maintaining global leadership in both research output quantity and citation impact. Analysis of institutional performance revealed that the University of California, San Francisco was the most active contributor with 52 published studies, while the University of Washington achieved exceptional recognition through accumulated citations reaching 2537, representing the highest citation metrics among participating institutions. Spine, European Spine Journal and Journal of Neurosurgery-spine are the top 3 productive journals on spondylolisthesis, indicating that there will be more high-quality publications on this topic published on these journals.

Bibliometric analysis revealed distinct thematic clusters in spondylolisthesis research, centering around core terminology including "spondylolisthesis", "isthmic spondylolisthesis", "degenerative spondylolisthesis", and "fusion" with scholarly focus undergoing temporal evolution. The temporal analysis demonstrated a paradigm shift from historical emphasis on "posterolateral fusion" techniques to contemporary preference for "interbody fusion" methodologies, reflecting evolving surgical approaches in this domain.

The most cited publication on spondylolisthesis was "Evaluation of specific stabilizing exercise in the treatment of chronic low back pain with radiologic diagnosis of spondylolysis or spondylolisthesis" by O'Sullivan et al[24] in 1997. They evaluated the efficacy of specific training of muscles surrounding the spine by performing a randomized, controlled trial, test-retest design, with a 3-month, 6-month, and 30-month postal questionnaire follow-up. They found that the specific exercise group showed a statistically significant reduction in pain intensity and functional disability levels.

"Degenerative Lumbar Spondylolisthesis with Spinal Stenosis - A Prospective-Study Comparing Decompression with Decompression and Intertransverse Process Arthrodesis" published by Herkowitz and Kurz[25] in 1991 was the second d most-cited article. They conducted a prospective clinical and imaging study of 50 patients with spinal stenosis associated with degenerative lumbar spondylolisthesis to determine whether concurrent intertransverse arthroplasty provided better outcomes than laminar decompression alone. They found that in the patients who had a concomitant arthrodesis, the results were significantly better with respect to relief of pain in the back and lower limbs.

"1997 Volvo Award winner in clinical studies - Degenerative lumbar spondylolisthesis with spinal stenosis: A prospective, randomized study comparing decompressive laminectomy and arthrodesis with and without spinal instrumentation" by Fischgrund et al[26] in 1997 was the third most-cited article. They analyzed the influence of transpedicular instruments on the operative treatment of patients with degenerative spondylolisthesis and spinal stenosis. Studies have found that in patients with degenerative lumbar spondylolisthesis with spinal stenosis, the use of pedicle screws may result in higher fusion rates, but clinical results have shown no improvement in back and lower extremity pain.

Limitations

This investigation conducted a bibliometric analysis of spondylolisthesis research using data sourced exclusively from the Web of Science Core Collection database. While employing systematic methodological approaches, three principal constraints warrant acknowledgment: (1) The inherent database limitations resulted in the unavoidable exclusion of seminal works not indexed within the Web of Science platform; (2) Linguistic constraints imposed by English-only inclusion criteria may have omitted impactful contributions published in other academic lingua francas; and (3) The dataset's temporal cutoff of September 2022 creates a dynamic parameter gap, though subsequent citation patterns are anticipated to maintain established trajectory profiles. These methodological boundaries notwithstanding, the study's core findings retain validity within defined parameters.

CONCLUSION

This scientometric investigation revealed a progressive growth in scholarly outputs addressing spondylolisthesis management during the last decade. Analysis of geographical contributions indicates that the United States maintains dominance in spinal pathology research productivity. Three principal periodicals emerged as leading knowledge dissemination platforms: Spine, European Spine Journal, and Journal of Neurosurgery Spine, collectively accounting for 18.7% of total publications. Contemporary research trajectories demonstrate intensified focus on intervertebral body fusion techniques and associated instrumentation innovations. Furthermore, our citation network analysis identifies seminal works within the century club (≥ 100 citations) that continue to shape current clinical paradigms, offering foundational guidance for subsequent investigators in this evolving orthopedic domain.