Bibliometric and trend analysis of the top 100 most-cited articles on anterior lumbar interbody fusion (ALIF).

Abstract

Anterior lumbar interbody fusion (ALIF) is a widely utilized spinal procedure supported by an expanding body of literature. However, the structure, influence, and thematic evolution of the most impactful studies remain incompletely characterized. This study aimed to analyze the bibliometric profile of the 100 most-cited ALIF publications. A bibliometric analysis was performed using the Web of Science Core Collection. The 100 most-cited ALIF-related articles were identified from database inception through 2025. Extracted data included authorship, journals, institutions, countries, and citation metrics. Analyses used the Bibliometrix R package to evaluate productivity, collaboration, and keyword trends. Dataset included 463 authors across 28 journals, with a mean of 5.4 authors per article and international collaboration (9%). The literature demonstrated high impact, with a mean document age of 15.2 years and an average of 125.4 citations per article. Publication output was concentrated in <i>Spine</i> (19%) and <i>The Spine Journal</i> (17%), while the United States contributed the highest citation share. The most-cited studies reached 365 citations, whereas recent publications showed high citation velocity (up to 32.4 citations/year). Research focus evolved from fusion outcomes and biomechanics toward complications and minimally invasive approaches. Most studies were retrospective. Influential ALIF literature is highly concentrated and shaped by both historically cited studies and emerging high-impact work. The findings highlight a potential divergence between citation prominence and evidence hierarchy, emphasizing the need for critical appraisal and more robust prospective research. This analysis provides a structured framework to understand historical trends, current priorities, and future directions in ALIF research.