This study utilized the Web of Science Core Collection (WoSCC) database, known for its comprehensive citation and publication data across various scientific disciplines.

Two investigators searched WoSCC on March 24, 2024, to identify relevant studies published from January 1, 1980, to March 24, 2024. The search terms were as follows: TS = (“Spin* Brucell*” OR “Brucell* Spondy*” OR “Brucell* Cervical”) AND publishing year = (1980–2024) AND document types = (articles & reviews & proceedings papers) AND language = (English). This search yielded 274 articles. The following categories were excluded: editorial material, letters, book chapters, meeting abstracts, early access, retractions, retracted publications, and corrections. A manual review was conducted to ensure the selected publications were directly relevant to BS research. This review involved two authors (Zhangui Gu and Zongqiang Yang), with any discrepancies resolved by the experienced corresponding author (Jiandang Shi). The search results were exported as a plain text file, with the record content comprising the “Full Record and Cited References.” The final analysis included 197 publications. The retrieval strategy employed in the study is illustrated in Figure 1.

The bibliometric analysis was conducted systematically, beginning with an overview of publications and countries/regions using Microsoft Office Excel Professional Plus 2016. The data were then imported into Biblioshiny (R version 4.3.3), CiteSpace (6.3.R1), and VOSviewer (1.6.20) for further analysis, including institutions, authors, journals, document citations, reference co-citations, keywords, and trends. The country collaboration map was created using Scimago Graphica (1.0.41).

Biblioshiny evaluates several bibliometric indicators to assess the output of authors, institutions, and journals. The number of articles measures productivity, total citations indicate the impact on the scientific community, and local citations assess the impact in specific fields. These dimensions are used to evaluate research quality. The h-index, which combines productivity and effect, indicates that a researcher has published h papers, each cited at least h times. Additionally, Biblioshiny plotted a three-field plot and authors’ production over time. Data exported from VOSviewer were used in Scimago Graphica to generate a geographic distribution map of BS publications (20). In the VOSviewer map, nodes represent items such as countries, organizations, and authors, with node size indicating the number of these items. Lines between nodes reflect the degree of cooperation or citation among projects, indicated by the same color (21). CiteSpace, a Java application for bibliometric analysis developed by Chen, supports knowledge mining and data visualization (22). It generated bibliographic citations, reference co-citations, keyword co-occurrences, keyword clusters, and timeline plots and analyzed keyword bursts representing trending themes over time. Microsoft Office Excel Plus 2016 was used to create annual production and average citation graphs.

The study included 197 publications, comprising 178 articles, 15 reviews, and 4 proceeding papers (Figure 1). The number of publications on BS has increased significantly, from 6 in 1999 to a peak of 18 in 2023 (Figure 2A). Figure 2B illustrates the trend in the number of BS-related publications and the average number of citations per year from 2009 to 2024.

Researchers from 33 countries contributed to BS research, with Turkey leading in the number of publications (62, 31.47%), followed by China (56, 28.43%), the USA (11, 5.58%), Greece (11, 5.58%), and Spain (10, 5.08%) (Figure 2C). Table 1 lists the top 10 countries in terms of publications. Turkey also ranks first in citation count with 1315 citations, followed by Spain (1109) and the USA (500) (Figure 2D), highlighting Turkey's significant influence in this field. Figure 3A presents a map showing the number of publications and cooperation strength between countries, with the USA initiating and participating in the most collaborations, though generally with fewer partnerships involving other countries.

A total of 269 institutions produced the 197 publications. Among the top 10 institutions (Table 1), Xinjiang Medical University published the highest number of articles (13, 6.60%), followed by Capital Medical University (7, 3.55%), Shandong University (6, 3.05%), Xi'an Jiaotong University (6, 3.05%), and Dicle University (5, 2.54%). Figure 3B illustrates the collaboration between these institutions, with a network map highlighting the 50 institutions that published at least two articles. The size of the circles in the map represents the number of publications and the extent of collaboration within the same cluster.

A total of 912 authors contributed to BS research. The top 10 authors, listed in Figure 4A, accounted for 46 publications (23.35%). Sheng WB was the most prolific, with 7 publications (3.55%), followed by Li T (5, 2.54%) and Cui XG (5, 2.54%). Figure 4B shows the publication years of the top 10 authors. Colmenero JD began his research on BS in 1992. Using the H-index and G-index for bibliometric assessment, Cui XG, Li T, and Colmenero JD emerged as the top three scholars in the field (Table 2). Figure 4C displays a network graph of authors with at least two publications, comprising 68 nodes and 13 clusters.

BS literature has been published in 130 academic journals, with the top 10 journals contributing 40 publications (20.30%) (Table 3). Rheumatology International and Medicine lead with 6 publications each (3.05%), followed by Spinal Cord (5, 2.54%) and Clinical Infectious Diseases (4, 2.03%). Figure 4D visualizes the distribution of authors across different topics and journals. The main research keywords among the top 20 authors include magnetic resonance imaging, spondylodiscitis, treatment, epidural abscess, brucellosis, and brucella spondylitis, with their work typically published in journals like Spine, European Spine Journal, and Medicine. A dual-map overlay of journals (Figure 5) shows BS article publications on the left and cited journals on the right, highlighting the topics covered by cited journals.

Based on WoSCC citation data, the top 10 cited papers globally and locally are shown in Figures 6A,B. The top three globally cited articles had 436, 402, and 199 citations, authored by Colmenero JD, Berbari EF, and Solera J, respectively. The top locally cited paper, by Javier Solera, focuses on BS diagnosis and treatment.

Co-cited references are depicted as nodes in Figure 7A, with the top three in terms of centrality intensity being “Brucellar spondylitis,” “Musculoskeletal involvement of brucellosis in different age groups: a study of 195 cases,” and “A case of brucella spondylodiscitis with extended, multiple-level involvement.” Figure 7B shows the top 20 references with the strongest citation bursts, highlighting their citation burst intensity and duration.

Figure 8A presents a high-frequency network map of keywords generated by CiteSpace. The keywords “spinal brucellosis” and “spondylitis” were predominant, along with frequently used terms like “complications,” “diagnosis,” and “involvement.”

Keyword clustering in Figure 8B reveals 11 significant research directions, including “epidural abscess,” “brucella melitensis,” “interbody fusion,” “brucellar spondylitis,” “brucella spondylitis,” “doxycycline,” “differential diagnosis,” “orthopaedist,” “turkey,” “leukoscan,” and “spondylodiscitis.”

The timeline view of keywords in Figure 8C shows that BS research primarily focuses on clinical studies, such as clinical features, diagnosis, imaging presentations, and complications. In recent years, areas like essential research and machine learning have emerged.

Keyword burst detection analysis reveals significant research trends and hotspots by identifying notable changes in keyword occurrence frequency (Figure 8D). Since 2020, the keywords with the strongest citation bursts are “management” (2021–2024), “instrumentation” (2021–2024), “spinal tuberculosis” (2021–2024), and “brucella spondylitis” (2022–2024). Trend Topics in Biblioshiny, shown in Figures 9A,B, further clarify abstract and keyword topic trends. These analyses indicate that “instrumentation,” “management,” and “debridement” have emerged as crucial research frontiers post-2020.

BS is an acute or chronic spinal infection caused by Brucella species. Key clinical manifestations include fever, persistent back pain, neurological symptoms, and systemic signs. In the early stages of the disease, the clinical presentation of BS closely resembles that of spinal tuberculosis and pyogenic spondylitis, and differentiating these conditions based on laboratory tests, imaging, and pathology is challenging, further complicating the diagnosis (23). Misdiagnosis or delayed diagnosis can result in severe complications such as spinal deformities, neurological impairment, or even permanent disability (24). Therefore, timely and accurate diagnosis and intervention are critical to prevent serious sequelae and to alleviate the economic burden on patients and society.

The treatment of BS is typically tailored according to the location and severity of the infection. Combination antibiotic therapy remains the cornerstone of treatment, with common regimens involving prolonged courses of antibiotics such as doxycycline and rifampicin (19). For patients experiencing neurological deficits or spinal instability, surgical intervention is often necessary. Common surgical procedures include debridement, interbody fusion, and mechanical stabilization using internal fixation devices (25). Minimally invasive surgical techniques have gained popularity due to their reduced trauma and faster recovery, making them particularly beneficial for patients with early-stage disease or mild neural compression. However, the choice of surgical approach should be based on the anatomical site of the lesion and the severity of the condition.

In recent years, significant advancements have been made in understanding the pathogenesis and optimizing treatment strategies for BS. This study utilizes a bibliometric analysis of literature from the WoSCC database, spanning from 1980 to 2024, to elucidate the current research landscape, emerging trends, and key research topics in the field. The insights gained from this analysis offer clear directions for future research on BS, facilitating critical advancements in both basic research and clinical management of the disease.

While the number of publications on BS remains lower than for other spinal infectious diseases like STB (26), there has been a significant increase in BS research from 1980 to 2024. Among the top five countries for BS publications, Turkey, Spain, and Greece, all in the Mediterranean region, contribute significantly, highlighting the higher prevalence of brucellosis in this area (4). Turkey leads with the highest number of papers (62, 31.47%) and total citations (1,315), likely due to a higher HB prevalence (27). China ranks second with 56 publications (28.43%) but has relatively low citations, indicating a need for improved research quality as HB has been re-emerging in China since the 1990s (28). Chinese research on BS began to surge in 2016, with Xinjiang Medical University and scholar Sheng WB making notable contributions. This aligns with earlier reports of high HB incidence in Chinese provinces like Ningxia, Xinjiang, and Inner Mongolia from 2016 to 2018 (29). In contrast, the incidence of HB in the United States dramatically declined during the 2000s (30), and BS cases are now rare (31). However, the U.S. has developed several influential clinical guidelines for diagnosing and treating BS (32). It plays a central role in international cooperation, particularly with Peru, Switzerland, India, Nepal, Iran, and China.

Among the top publishing institutions, five in China and four in Turkey have made significant contributions. However, the cooperation network diagram (Figure 3B) indicates that inter-institutional collaboration needs strengthening. Publications on BS are frequently found in Rheumatology International and Medicine, followed by Spinal Cord and Clinical Infectious Diseases. Influential studies by scholars like Bodur H, Ozden M, and Geyik MF form the foundational knowledge base of BS, providing critical insights into its clinical features and treatment. Citation analysis shows that works by Colmenero JD and Erdem H have a significant impact, with recent studies by Liang C and Esmaeilnejad-Ganji SM continuing to attract attention (33–39).

The high-frequency co-occurrence of specific keywords highlights research hotspots in BS. The top five keywords are “Spinal brucellosis,” “Spondylitis,” “Complications,” “Diagnosis,” and “Involvement.” These terms dominate BS research, indicating key study areas (Figure 8A). “Involvement” and “complications” in BS research refer to osteoarticular involvement, a common brucellosis complication, and complications from BS progression, such as systemic symptoms, localized muscle spasms, radicular pain due to abscess compression, and spinal cord involvement leading to sensory or motor impairment or restricted spinal motion. medication-induced adverse drug reactions and surgical complications are also significant (40, 41). Due to the non-specific nature of early clinical signs, imaging manifestations, slow blood bacterial culture growth, and complex serodiagnosis, BS remains challenging to differentiate from atypical spinal metastases, STB, and other infectious diseases (42). The keyword “diagnostics” highlights the need for breakthroughs in recognizing these hard-to-distinguish diseases and serious complications. Many studies have explored clinical features, laboratory tests, microbiological tests, imaging, and machine learning for diagnostic advancements (8, 11, 19, 43–49).

The keyword “tuberculous spondylitis” had a burst from 1994 to 2008 and re-emerged as “spinal tuberculosis” from 2021 to 2024 (Figure 8D). This resurgence may reflect early diagnostic and therapeutic confusion between BS and STB, with recent advances in imaging and machine learning offering a deeper understanding of both diseases. Abstract analysis using the trigrams algorithm indicates a focus on clinical studies, with fewer basic studies (Figure 9A). Keyword co-occurrence, indicating a sudden increase in keyword citations, measures a keyword's influence and importance, reflecting research frontiers at specific times. Figures 8D, 9B show that “Instrumentation,” “Management,” and “Debridement” are research frontiers post-2020. Beyond bibliometric software predictions, machine learning could emerge as a research frontier after 2023.

Management of BS varies by the affected body part. Treatment options include prolonged antibiotic therapy and surgical intervention. Standard antibiotic regimens for patients without focal disease include doxycycline (100 mg BID) for six weeks combined with an aminoglycoside (gentamicin 5 mg/kg/day OD for 7–10 days or streptomycin 1 g OD for 2–3 weeks) or rifampicin (600–900 mg OD) plus doxycycline (100 mg BID) for six weeks (50, 51). The Infectious Diseases Society of America (IDSA) recommends three months of antimicrobial therapy for most BS patients (32). The two most common regimens are streptomycin for 2–3 weeks with doxycycline for three months or doxycycline and rifampin, both for three months (52). The triple antibiotic regimen—rifampicin (600–900 mg OD for a minimum of 12 weeks), doxycycline (100 mg BID for a minimum of 12 weeks), and streptomycin (1 g OD for 2–3 weeks) or gentamicin (5 mg/kg/d OD for 5–7 days)—is effective and associated with lower recurrence rates (53).

Surgical management is indicated for patients with neurological symptoms due to spinal instability, spinal disruption, or epidural abscesses (54). The rise of “Instrumentation” and “Debridement” keywords indicates increased attention to surgical options. Evidence shows that spinal instrumentation is safe for patients with spinal infections (55). Traditional open surgery is recommended for patients with spinal instability, spinal cord or nerve compression, or progressive kyphosis deformity. Main surgical approaches include anterior debridement, posterior decompression (with or without instruments), and combined anterior and posterior approaches (56, 57).

Liu et al. conducted simple anterior lesion excision with internal fixation in six BS patients with cervical spine instability and cervical epidural abscess, recommending decompression and fusion for patients with combined cervical epidural abscesses (58). Yin et al. performed one-stage anterior internal fixation, debridement, and fusion in 16 lumbar brucella spondylitis (LBS) cases, concluding that this approach is safe and effective for LBS patients with spinal instability and abscess compression without posterior column involvement (59). Further studies indicate that posterior pedicle fixation, debridement, and interbody fusion are superior treatment options (18, 56, 57, 60–62). Wang et al. demonstrated that minimally invasive surgery for LBS involving portal endoscopic decompression, debridement, and interbody fusion with percutaneous screw fixation, is practical, safe, and feasible (63). The optimal surgical approach for BS remains debated and should be based on lesion location, degree of spondylolisthesis and nerve compression, and surgeon skill.