Spinal neurosurgery: Trends in female authorship contribution over 5-Year publication history.

In the last few years, more efforts have been made to increase gender equity in medical specialties. Nevertheless, spinal neurosurgery continues to be one of the most male-dominated subspecialties in neurosurgery. This bibliometric analysis sought to explore the representation of female authors in major neurosurgical publications between September 2017 and August 2022, with a focus on first and last authorship roles across journals and countries. The paper analyzed 3171 unique publications within a framework of 93 high-impact neurosurgery-related journals. Results showed that female authors were 14,25 % of first authors and 7,88 % of last authors, and that only 2,11 % of articles had both female first and last authors. Country of affiliation and the journal of publication significantly influenced the author's gender representations, with Scandinavian states and certain journals, like Neurocritical Care, showing relatively high percentages of female authorship. Even if there has been minor progress over the recent past, disparities nowadays persist, potentially limiting diversity in perspectives and advancements in this field. These disparities underline the presence and the influence of systemic and cultural factors impeding gender equity, and underscoring the critical need for proactive measures to foster it, including mentorship programs, institutional support, and policies for balanced opportunities. The COVID-19 pandemic amplified inequities in this field, disproportionately impacting female academics due to increased domestic responsibilities without the corresponding implementation of support systems. The significant role of mentorship in improving female representation was also highlighted by this analysis: our data indicated higher collaboration rates between female first and last authors in the field of spinal neurosurgery. To address these challenges, efforts must be made starting during residency, with the aim of targeting systemic barriers and cultural biases. The implementation of inclusive policies, like on-site childcare programs, and fostering international collaboration, might help to reduce these disparities and to ensure that diversity drives innovation in spinal neurosurgery. Such an approach is essential for addressing inequity, which is not merely a matter of fairness but is central to advancing the field. This would ensure that only talent and hard work are what determine success in spinal neurosurgery, which is imperative for the progress of the speciality, enabling diverse perspectives to shape the future of patient care, research, and academic leadership.