Growing trend of China's contribution to the field of spine: a 10-year survey of the literature

China, as a rapidly developing country with the largest population including over 50,000 orthopaedic surgeons, has an increasing importance in the field of spine. However, the quantity and quality of research production in the field of spine in the major regions of China-Mainland China, Taiwan, and Hong Kong is unclear. This study aimed to investigate the contribution of China to the field of spine. Articles published in the 5 major spine journals originating from Mainland China, Taiwan and Hong Kong in 2004-2013 were retrieved from the database of Web of Science. The number of articles, impact factors, citations, article type, city, institution, funding source and conflict of interest were analyzed. There were 1006 publications in the 5 spine journals between 2004 and 2013 from China, including 706 from Mainland China, 210 from Taiwan, and 90 from Hong Kong. The time trend of the number of articles from these three regions showed a significant increase of 8.74-fold (from 23 to 201) between 2004 and 2013 (p = 0.000). From 2006, the number of publications from Mainland China exceeded Taiwan and Hong Kong. Mainland China had the highest total impact factors (1686.54) and total citations (4214), followed by Taiwan (498.93; 2009) and Hong Kong (222.89; 1311). Hong Kong had the highest mean impact factor (2.48) and mean citations (14.46), followed by Mainland China (2.40; 10.26) and Taiwan (2.38; 10.14). The journal Spine published the largest number of articles (470), followed by European Spine Journal (268). Chinese contributions to the field of spine have a significant increase during the past 10 years, particularly from Mainland China. Hong Kong had the highest quality research output in terms of mean impact factor and mean citation per article.