The evidence gathered for SSP, or spinal surgical practice, is almost related to the quality of published clinical researches. In the hierarchy of study designs, the quality of evidence from a randomized controlled trial or RCT and meta-analysis is considered better than other types of prospective and retrospective study designs. We assessed the evidence level in studies published between 1983 and 2011 in 4 journals, posting predominantly on spine-related topics. A computerized search of the Medline database was undertaken to evaluate the articles published in 4 ‘spinal’ journals between1983 and 2011. 

From around 21775 articles evaluated, there were 888 RCTs, 93) meta-analysis and 1355) other clinical trials. Overall, comparing the periods 1983-7 with 2008-11, there were increases in the proportion of RCTs, a meta-analysis and other clinical trials, and a decrease in the ratio of other articles published. The researchers have gone through all the studies related to spinal surgery. However, there is some more to it. The researchers are still studying the research works from 2011 to now. They have considered all types of information available for the study. The spinal surgical practice has improved a lot in these two decades. And hopefully, there’s more to come.