In 2023, JSS reviewers continue to make outstanding contributions to the peer review process. They demonstrated professional effort and enthusiasm in their reviews and provided comments that genuinely help the authors to enhance their work.

Hereby, we would like to highlight some of our outstanding reviewers, with a brief interview of their thoughts and insights as a reviewer. Allow us to express our heartfelt gratitude for their tremendous effort and valuable contributions to the scientific process.

January, 2023
Ian J Wellington, University of Connecticut, USA

February, 2023
Taige Cao, Sengkang General Hospital, Singapore

March, 2023
Lauren E Stone, University California San Diego, USA

April, 2023
Anthony L Mikula, Mayo Clinic, USA
Netanja I Harlianto, Utrecht University, the Netherlands

May, 2023
Ehsan Dowlati, University of Michigan, USA

June, 2023
Bryan Zheng, Brown University, USA
Takeshi Hara, Juntendo University Hospital, Japan

July, 2023
Siegmund Lang, University Hospital Regensburg, Germany

August, 2023
Austin Q Nguyen, Houston Methodist Hospital, USA

September, 2023
Shiying Wu, Sengkang General Hospital, Singapore

October, 2023
Akira Itoi, Shizuoka Hospital, Japan

November, 2023
Bryan Menapace, Nemours Hospital, USA
Lakshmi N. Kurnutala, University of Mississippi Medical Center, USA
Takeshi Oki, Yuki Hospital, Japan

December, 2023
Andrew Y Powers, Beth Israel Deaconess Medical Center, USA

January, 2023

Ian J Wellington

Dr. Ian James Wellington is a senior resident in orthopedic surgery focused on spine surgery at the University of Connecticut, USA. He completed his undergraduate degree in neuroscience at Bucknell University before attending medical school at the University of Maryland. During his residency, he completed a dedicated research year as the Neag Chase research fellow, during which he conducted cadaveric biomechanical studies and clinical outcomes research in spine, sports, and hand surgery. His current research interests are minimally invasive spine surgery techniques and implant biomechanics. A list of Dr. Wellington’s research can be found here.

The way Dr. Wellington sees it, reviewers are the backbone of modern academic literature. With the recent increase in open-access online-only publications, the volume of research output has exploded. The large growth in research quantity can place its quality at risk. As such, reviewers provide a means of ensuring that scientifically sound studies are produced and shared with other academics. To him, a good reviewer should have a well-rounded understanding of not only the topic of the manuscript they are reviewing but also the kind of research being conducted. For example, for a biomechanics manuscript, a good reviewer should have an intimate understanding of biomechanics study design. Having a familiar understanding of standard statistical analyses is also fundamental for a good reviewer, as errors in statistical methodology have large impacts on the quality of a study. Finally, he points out that good reviewers should see themselves not as academic gatekeepers, but as members of a research team. They are to help the authors elevate the quality of the manuscript so that it can be more impactful rather than simply deciding if a work is acceptable for publication.

Viewing from a reviewer’s perspective, Dr. Wellington emphasizes that seeking institutional review board (IRB) approval is fundamental to the integrity of modern research. Before IRBs became standard practice, research harmful to its subjects was prevalent. From the Stanford Prison Experiment to the Tuskegee Syphilis Study, research was capable of causing long-term harm to “participants”. While these studies have damaged those involved, they also bred distrust in the scientific community from the general public. In his opinion, IRBs provide a safeguard against these kinds of studies, ensure the safety of the public, and facilitate proper research practices.

“I review for a few reasons. I feel that reviewing encourages me to dive deeper into the current literature surrounding the topic of whatever I’m reviewing. This facilitates me to expand my understanding of different subject matters. Additionally, reviewing forces me to critically evaluate study designs and methods, which helps me when designing my own studies. Finally, as someone who relies on the suggestions of reviewers evaluating my own work, I feel that I owe it to others to review their work,” says Dr. Wellington.

(by Brad Li, Alisa Lu)

February, 2023

Taige Cao

Dr. Taige Cao is a dermatologist at Sengkang General Hospital, specializing in eczema, psoriasis, itch, and minimally invasive aesthetic procedures. He earned his medical degree from the National University of Singapore and completed his dermatology training at the National Skin Centre. With a remarkable career, Dr. Cao achieved Distinction in Postgraduate Diploma in Dermatology from Queen Mary, University of London and passed the Specialty Certificate Examination in Dermatology from the Royal College of Physicians (UK). Beyond Western medicine, he is a registered acupuncturist, embracing the holistic approach of Traditional Chinese Medicine. He encourages patients to actively participate in their health by exploring health beliefs, practices, diet, and lifestyle. Furthermore, Dr. Cao is devoted to medical education and holds the position of Clinical Assistant Professor at Duke-NUS Medical School, imparting his knowledge to patients and fellow medical professionals alike.

As a reviewer, Dr. Cao thinks it is imperative that the peer-review process remains impartial and trustworthy. To ensure this, he has taken steps to educate himself on common unconscious biases that might affect judgment. Awareness of these biases is the first step, but he believes it is equally crucial to actively counteract them. Instead of relying on subjective feelings or perceptions, he strictly adheres to using clear and objective criteria for evaluation. These criteria help ensure that every paper is assessed based purely on its scientific merit and the validity of its content. Another essential aspect of maintaining integrity in the review process, in his opinion, is recognizing and addressing potential conflicts of interest (COIs). Whether a paper is authored by someone he might know personally or professionally, or if there is any other reason his impartiality could be compromised, he makes it a point to recuse himself. And finally, irrespective of previous experiences or pre-existing opinions, he strives to approach each paper with a fresh perspective. This approach guarantees that every author gets a fair and unbiased evaluation, upholding the sanctity of the peer-review process.

From a reviewer’s perspective, Dr. Cao recognizes the paramount importance of transparently addressing COIs within the research he assesses. This understanding extends beyond mere protocol—it is integral to maintaining trust and ensuring the credibility of the studies one evaluates. A COI, though not automatically discrediting, can introduce nuances and potential biases in research. By diligently looking for and considering these disclosures, he believes one can provide a balanced and informed critique, ensuring that the integrity of the research process is upheld.

“Engaging in peer reviewing is both a privilege and a continuous learning journey for me. It grants me early access to groundbreaking research, sharpening my analytical and critical thinking skills as I assess the quality and integrity of new studies. This process doesn't just enhance my expertise but also solidifies my role in upholding the standards of our academic community. I relish the chance to connect with diverse perspectives and methodologies from around the globe,” says Dr. Cao.

(by Brad Li, Alisa Lu)

March, 2023

Lauren E Stone

Dr. Lauren Stone is a neurosurgery resident at the University California San Diego, USA. After completing an undergraduate degree in clarinet performance, she matriculated into Lewis Katz School of Medicine where she was first exposed to spine surgery. In residency, she has trained in both adult and pediatric deformity with intention of pursuing a post-graduation clinical fellowship in complex spine surgery. Her research interests include the psychometric properties of patient reported outcome metrics and applications of predictive analytics for precision surgical planning. Connect with Dr. Stone on X @LaurenStoneMD.

JSS: Why do we need peer review? What is so important about it?

Dr. Stone: We regard peer review as a statement of belief in our community’s pooled expertise. In a specialty that necessarily learns from other’s experiences, peer review opens discourse over what are important additions to group knowledge. This is a semi-democratized process that depends on community engagement. While effort is involved, the result is a thoughtful, intentional surgical community.

JSS: Peer reviewing is often anonymous and non-profitable, what motivates you to do so?

Dr. Stone: For those reasons exactly. There is no publicized reward or monetary incentive to peer review. Stripped of these motivations, the desire to participate in must come from something else – a belief in “paying it forward”, a duty to an academic community, etc. These alternate motivations are more outward focused, rooted to hope of continued integrity in our speciality, and – thus – do not require short-term rewards to sustain.

JSS: Data sharing is prevalent in scientific writing in recent years. Do you think it is crucial for authors to share their research data? And why?

Dr. Stone: Data sharing, and more pointedly, metadata/code gives credence to study reproducibility and generalizability. Research becomes more impactful if it is transparent because the barriers to application are generally lower. While some circumstances may not permit sharing, it is preferable if these are the exception, not the rule.

(By Lareina Lim, Brad Li)

April, 2023

Anthony L Mikula

Dr. Anthony L. Mikula, MD, is an enfolded neurosurgery spine fellow at Mayo Clinic in Rochester, MN, USA, pursuing a career as an academic spine surgeon. He completed his Bachelor of Science in Biochemistry at the University of Minnesota and then earned his Doctor of Medicine degree at the University of Wisconsin – Madison. Since joining residency, he has published numerous peer-reviewed publications, presented at national spine meetings, won the resident teacher of the year award, and earned top resident abstract awards at the joint AANS/CNS spine section meeting the last five years in a row. He also completed an enfolded fellowship in spinal oncology at MD Anderson with Dr. Laurence Rhines that was supported by a NREF Directed Residency Scholarship. After graduating residency next year, he will complete a spinal deformity and spine tumor fellowship at the University of California – San Francisco with Dr. Chris Ames. You may connect with Dr. Mikula on Twitter @anthony_mikula.

To Dr. Mikula, the true value of peer review lies in the ability to improve one’s work. When experts weigh in on another group’s work, it provides a fresh perspective that can augment the study. It can also provide clarity for points within the manuscript the authors may feel are obvious but need to be explained further for the reader. Another benefit of peer review is to ensure a clear message is delivered by the work. He explains, “Too often, we as writers can get lost in the details when a clear and simple message can be the most effective manuscript.”

However, the peer-review system has limitations, which include the small number of reviewers that get to provide feedback for a manuscript. This provides a relatively small survey considering the number of readers a manuscript can reach, and occasionally the feedback does not represent the general sentiment of the overall group. This limitation could theoretically be addressed by having more reviewers, but that additional time requirement may not be realistic. In view of this, Dr. Mikula points out that a solution may be a “rapid review” by a panel of 5-10 reviewers and if the manuscript passes that stage, a more thorough review could be provided by 2-3 people. Another limitation is the “group think” that can happen when reviewers see the feedback provided by previous reviewers. “Often the consecutive reviewers will follow the lead of the first reviewer. This could be solved by simply keeping all the reviewers blinded to each other’s feedback,” he shares.

As a trainee, Dr. Mikula finds it challenging to allocate time to do peer review as he has little control over his schedules. With a busy clinical schedule, academic time is often limited to nights and weekends. But as an attending surgeon, there may be more opportunity to build in academic time that could be set aside for tasks such as peer review. Nevertheless, he believes that it is a privilege to be a reviewer, and emphasizes that as authors often spend countless hours on a study and the associated manuscript, playing a small role in that process is very rewarding.

From a reviewer’s perspective, Dr. Mikula feels the reporting guidelines do serve an important role of ensuring the essentials of a study and associated manuscript are in place. They also create a common language for presenting work that is familiar to the authors, reviewers, and readers, providing structure and clarity to the manuscript.

(by Teresa Lin, Brad Li)

Netanja I Harlianto

Dr. Netanja Harlianto obtained his medical degree from Utrecht University, Netherlands, and is currently pursuing a PhD and Epidemiology degree in the field of orthopedic surgery. He has a broad research interest, including metastatic tumors of the spine, metabolic spinal disorders, joint arthroplasty, spinal trauma surgery, as well as projects related to population health in oncology, trauma, and musculoskeletal disease. You may connect with Dr. Harlianto on LinkedIn.

In the current peer-review system, there is a disproportionate number of reviewers compared to the number of submitted articles, which, in Dr. Harlianto’s opinion, may make it difficult to find suitable peer reviewers with sufficient subject knowledge. As a result, review times are delayed, as well as the dissemination of results to the general public. Increased efforts for reviewer recognition have been made available in recent years to encourage reviewers, including review verification via Web of Science, the benefit of reduced article processing fees, and temporary access to the full issue of the journal to tackle this issue. Moreover, biases may exist against the author, which may be reduced by employing double-blinded peer-review practices. For accepted articles, post-publication peer review may also benefit from higher transparency when the reviewer reports are made available (either signed or anonymized) alongside the published article.

As a reviewer, Dr. Harlianto thinks it is important to identify the strengths and limitations of a research paper, how authors can overcome these shortcomings, and provide them with feasible and constructive feedback. Reviewers should be aware of the time they may need, in order to complete the review in a timely manner and prevent additional delays in the peer-review process. In addition, it is important to mention if there are sections of the paper that the reviewers are not qualified to review, thus only provide feedback on areas that the reviewers are knowledgeable in (e.g. certain statistical methodologies).

Although peer review is usually anonymous, Dr. Harlianto believes that peer review is an essential aspect of science, given that editors and reviewers also invest their time in evaluating one’s own submitted work for publication. Furthermore, peer reviewing may enable one to learn from one’s peers while remaining critical with regards to the quality of work, the methods used, and the validity of the evaluated results. It showcases a commitment to the scientific field, helps one to stay up to date with the latest trends and developments, and may inspire new research ideas and experimental techniques.

On the other hand, Dr. Harlianto believes data sharing is a crucial aspect for advancing science with regards to the reproducibility of results, the verification of findings, and the reuse of existing data. Data sharing has the potential to improve research quality, thereby accelerating scientific progress and practical knowledge.

(by Teresa Lin, Brad Li)

May 2023

Ehsan Dowlati

Dr. Ehsan Dowlati is a current endovascular neurosurgery fellow at the University of Michigan in Ann Arbor, MI, USA. He received a BS in Neuroscience and MS in Biotechnology at Johns Hopkins University in Baltimore, MD. He subsequently attended Virginia Tech Carilion School of Medicine in Roanoke, VA, where he was inducted into Alpha Omega Alpha (AOA) and received Academic Distinction in Research. He completed a neurosurgical residency at Georgetown University Hospital in Washington, DC, where he also completed an enfolded fellowship in minimally invasive spine surgery. He has co-authored over 60 peer-reviewed articles and multiple book chapters, earning him the Amy and Ed Knight Research Award in Neurosurgery in 2023. He has research interests in neurosurgical outcomes, cerebrovascular neurosurgery, and neurocritical care. Find more about Dr. Dowlati’s work through his ResearchGate and PubMed page, and connect with him on LinkedIn and Twitter.

In Dr. Dowlati’s opinion, limitations surrounding peer review typically involve finding reviewers to commit time to the process given that it is almost always anonymous and there is no financial incentive. Journals can provide some recognition to reviewers who provide their time to this important process.

Dr. Dowlati acknowledges that there is inherent bias in all manuscripts and the review process. To minimize this, the review must be an evidence-based evaluation of the methodology and results and based on the existing body of literature. Double-blind review with anonymization of authors and institutions as well as the reviewer is key. Additionally, authors should be encouraged to use standardized guidelines such as STROBE to try to make the process more objective.

Dr. Dowlati believes that being a reviewer is certainly one way to contribute to one’s field of expertise and advancing science. Although it can be time consuming, reviewers have the benefit of keeping up to date on research by being the first to view and analyze new potential studies. Peer review can also help inspire new ideas from authors’ work. Thus, there are intangible benefits of reviewing. He encourages everyone to devote some time to the peer-review process to participate in both their own academic development as well as advancement of science.

Lastly, Dr. Dowlati believes that it is important for authors to have their data readily available upon request. If there are cases that require replication of studies or collaboration or meta-analyses, the raw data become an important source of information. Data sharing allows for more collective and collaborative efforts.

(by Teresa Lin, Brad Li)

June 2023

Bryan Zheng

Bryan is a medical student at Brown University, Providence, Rhode Island, USA, with a degree in applied physics from Cornell University. He has published work in multiple facets of neurosurgery, including several studies on outcomes after spine surgery under principal investigator Dr. Jared Fridley and department chair Dr. Ziya Gokaslan.

Bryan believes the peer-review system may benefit from more quality control. The most frustrating review is absolutely not the harsh and critical one, but the one where there was no apparent effort to engage with the material or give it a fair chance. He explains, “While I can only speak for myself, I would guess most other authors would agree. The ‘meta-review’ of the spectrum of potential feedback an article receives seems to mostly fall on editors. But the whole process could be improved by a systematic and transparent dedicated process as well as personnel for ensuring worthwhile reviews.”

There are many qualities a reviewer should possess. In Bryan’s opinion, objectivity is obviously a must. A reviewer should also be willing to deeply engage with the material and even put oneself into the authors’ minds. In his personal experience, it is always gratifying to receive a review where the reader clearly tried to understand the motivations and process that led to the words on the page, even if it is overwhelmingly negative and the reason for rejection. These are often the most helpful to everyone, resulting in actionable feedback to improve a manuscript while preventing the publication of substandard work.

As a reviewer, Bryan thinks reporting guidelines are important for authors to be aware of and follow. He appreciates that the scientific community generally emphasizes reports that follow these criteria but does not always require strict confirmation of them (approximately 90% compliance rate). The latter might result in a rigid body of literature - some of the most impactful results in neurosurgery at every level of evidence to both clinical decision-making and patient outcomes may not be “perfect” CONSORT/STROBE/PRISMA papers.

“Trying to publish results without at least occasionally taking the time to help peers review their works would feel selfish. It only feels right to pay it forward,” says Bryan.

(by Teresa Lin, Brad Li)

Takeshi Hara

Dr. Takeshi Hara is a neurosurgeon at Juntendo University Hospital, Japan, specializing in biomechanics of spine, full endoscopic spine surgery, and minimally invasive spine surgery. He completed his neurosurgery training at the Juntendo University Hospital. He is also a spinal surgeon at the Juntendo University Spine and Spinal Cord Center, where he collaborates with orthopedic surgeons in surgery and medical treatment. His current research work includes diagnosis and management of tethered cord syndrome and a survey study on ADL of adult spina bifida patients in Japan. Furthermore, he is responsible for the medical education for medical students and serves as an assistant professor at Juntendo University School of Medicine, where he conveys his knowledge to patients, students, and health care providers.

It is important to Dr. Hara to have reviewers who take a sincere attitude to evaluate papers. There needs to be an appropriate and no special relationship between authors and reviewers. Reviewers also need to have an unbiased perspective. It is essential for them to always read the manuscript from cover to cover, examine the content thoroughly, and conduct the review impartially. This attitude will lead to a fair evaluation of the paper. He always tries to reads papers in as much detail as possible to make an unbiased decision.

For Dr. Hara, the value of conducting peer review is that it allows ones to obtain the most up-to-date knowledge. This involves reviewing papers for exposure to new knowledge and organizing peripheral knowledge to assess paper content. Conducting review will also lead to the development of the reviewer's skills. Training reviewers to critically and constructively examine the content of papers will help them develop their clinical acumen.

From a reviewer’s perspective, Dr. Hara believes it is crucial for authors to share data from their study to make the paper more transparent and credible. One of the most essential aspects of a review is assessing the credibility of the results. Thus, data sharing is vital to maintain trust between authors and reviewers.

(by Teresa Lin, Brad Li)

July, 2023

Siegmund Lang

Dr. Siegmund Lang is an Associate Professor for Orthopedic and Trauma Surgery at the University Hospital Regensburg, Germany, with a strong focus on spine surgery. He earned his medical degree from the University of Regensburg and achieved the German board certification in early 2023. In June 2023, he began his role as a Spine Clinical Instructor in the Department of Neurosurgery at Stanford Hospital, CA, USA. Dr. Lang completed his residency in orthopedic and trauma surgery at the University Hospital Regensburg and the Schulthess Clinic in Zurich, Switzerland, followed by an AOSpine fellowship at the BGU Clinic in Frankfurt am Main, Germany. His research interests span a wide range of topics, from epidemiological studies of spinal conditions and understanding the pathogenesis of spinal infections, to identifying biomarkers for diagnosing and gauging the severity of spondylodiscitis. He currently explores the cutting-edge potential of AI in healthcare, especially in spine surgery. Connect with Dr. Lang on LinkedIn and a list of his research work is available on ResearchGate.

JSS: What do you regard as a healthy peer-review system?

Dr. Lang: A healthy peer-review system is a cornerstone of scientific integrity, acting as the gatekeeper for the dissemination of knowledge. At its core, it should champion objectivity, transparency, and fairness, ensuring that every manuscript is evaluated on its merits rather than extraneous factors. Reviewers should be chosen based on their expertise and track record, ensuring they can provide insightful and unbiased feedback. A robust system needs to actively combat the rise of “predatory journals”, emphasizing rigorous review standards over superficial metrics. Furthermore, it would continuously evolve, incorporating feedback from authors, reviewers, and readers, and adapting to the changing landscape of scientific research.

JSS: What are the limitations of the existing peer-review system? What can be done to improve it?

Dr. Lang: The current peer-review system has several limitations, including potential biases, inconsistency in review quality, and the often unpaid and time-consuming nature of the task, which can deter potential reviewers. To address these issues, journals could offer monetary incentives or other forms of recognition for high-quality reviews. Implementing training courses, as offered by several professional societies, could be useful to standardize the review process and enhance its quality, tailored to the journal's guidelines. Regular educational sessions, such as online videos, could also help in maintaining and updating the skills of reviewers. Additionally, the integration of Artificial Intelligence (AI), like large language models (LLMs), presents an opportunity to assist in initial manuscript screening, plagiarism checks, and even quality assessment of statistical analyses. However, it would be crucial to strike a balance and use AI as a tool to complement human expertise, ensuring we don't miss nuanced insights or introduce biases present in the training data.

JSS: Peer reviewing is often anonymous and non-profitable, what motivates you to do so?

Dr. Lang: While peer reviewing is often done without direct monetary compensation, the intrinsic rewards are manifold. It offers me an opportunity to stay updated with the latest research in spine surgery, provides insights into the current standards of scientific writing, and helps in refining one's own research and manuscripts. Moreover, contributing to the scientific community and ensuring the publication of high-quality research is a motivation in itself.

JSS: Is it important for authors to disclose Conflict of Interest (COI)? To what extent would COI influence research?

Dr. Lang: Without a doubt, being upfront about COI is essential to maintaining the honesty and credibility of scientific endeavors. Any form of COI, be it monetary, scholarly, or personal, has the power to sway the results and conclusions of research. By laying these cards on the table, we allow readers and peers to assess the work with all its nuances in mind. Keeping such interests hidden not only jeopardizes the integrity of the study but also tarnishes the standing of the researchers involved. In my opinion, a COI can range from subtly biasing the framing of research questions and interpretation of results, to more overtly skewing data collection and analysis, potentially leading to misleading conclusions that serve the interest in question rather than the broader scientific community.

(By Lareina Lim, Brad Li)

August, 2023

Austin Q Nguyen

Austin Nguyen, MD, is an Orthopedic Surgery Resident at Houston Methodist Hospital with an interest in degenerative and minimally invasive spine surgery. He completed his Bachelor of Science in Biology with a minor in Psychology at the University of Illinois at Chicago, graduating summa cum laude and Phi Beta Kappa with the highest honors. He continued his medical school training at the University of Illinois College of Medicine in Chicago, graduating at the top of his class and as a member of the Alpha Omega Alpha (AOA) Medical Honor Society. Dr. Nguyen is committed to providing patient-centered care, engaging in research, and facilitating patient education as he progresses through his Orthopedic Surgery training. He is dedicated to staying up-to-date with the latest research and cutting-edge technologies, and is constantly striving to be a lifelong learner who practices evidence-based medicine. Connect with him on LinkedIn and Twitter @AustinNguyenMD.

According to Dr. Nguyen, peer review in spine surgery research maintains the discipline's credibility. Surgeons across the world engage in this process to ensure the validity of studies, which reinforces evidence-based practices and are vital for optimizing patient care. Despite its anonymous and non-profit nature, the intrinsic motivation to peer review lies in upholding standards and contributing to the advancement of clinical care within the field. As an orthopedic surgery resident aspiring to specialize in spine surgery, his intrinsic motivation stems from contributing to the field's growth, ensuring the validity of research, and ultimately enhancing patient care. The sense of duty to maintain the integrity of spine literature and improve clinical outcomes fuels the dedication to rigorous and unbiased evaluations within the peer-review process.

Data sharing is crucial for advancing spine surgery. In Dr. Nguyen’s opinion, this transparency fosters reproducibility, allowing colleagues to validate findings and build upon them. In the complex realm of spine surgery, shared data accelerates innovation, refines interventions, and collectively propels the field forward, ultimately benefiting patients through improved treatments and outcomes.

(by Lareina Lim, Brad Li)

September, 2023

Shiying Wu

Dr. Shiying Wu is a final year radiology resident in Singapore. After completing an undergraduate degree in medicine at the Monash School of Medicine (Clayton Campus), she completed her internship in Australia. In residency, she has been trained in various subspecialities, with a keen interest in general radiology; in particular, spinal imaging. Her research interests include neuroimaging, with a focus on diagnostic dilemmas in spinal imaging.

In Dr. Wu’s opinion, peer review ensures the integrity and rigor of science, to ensure that published articles are accurate, valid and original. She regards the peer-review process as the cornerstone of thoroughly conducted research, the promulgation of sound “evidence-based” clinical practice, backed by solid scientific knowledge, the expertise of the surgical community, and the critical thinking skills of scientific researchers.

The limitations of the peer-review process are multifold according to Dr. Wu. There may be inherent bias, gaps in reviewer knowledge and limitations of prior experience. A stringent peer-review system and multi-faceted approach may be relevant to surmounting these challenges. Initial involvement of junior editors to ensure subject matter relevance and fit for the journal, followed by junior researchers with knowledge of the subject matter, with final participation by subject experts and senior editors would be useful. Increasing the transparency and efficiency of the peer-review process would also be beneficial.

Dr. Wu indicates that though peer reviewing is often anonymous and non-profitable, the voluntary and non-compensatory nature of peer review may serve as an incentive to researchers, who would benefit from being part of a community of critical thinkers, staying current with ground-breaking research, ensuring continuation of professional development, as well as promoting the practice of evidence-based clinical care. Entrenched principles of science may be further evaluated and investigated through this process, with the aim of continued evolution of scientific knowledge achieved through a multi-pronged approach.

(by Lareina Lim, Brad Li)

October, 2023

Akira Itoi

Dr. Akira Itoi currently serves at Department of Orthopaedic Surgery, Juntendo University, Shizuoka Hospital, Japan. His researches focus on Spinal Trauma and Osteoporosis. His recent projects are AI-based diagnosis of osteoporosis/development of reconstruction methods for osteoporotic vertebral fractures.

In Dr. Itoi’s opinion, peer review is necessary to objectively determine logical inconsistencies that the authors may overlook on their own and make the paper even better. For reviewers, the logical structure of the paper must be understood correctly. If there are any inconsistencies, they should be pointed out logically, including suggestions for improvement.

“Even if peer reviewing is often anonymous and non-profitable, I am keen on doing so because I would like to contribute to medicine and it is also my interest,” says Dr. Itoi.

(By Lareina Lim, Brad Li)

November, 2023

Bryan Menapace

Bryan Menapace is a pediatric orthopaedic surgery fellow at Nemours Hospital in Delaware (formerly A.I. Dupont). He graduated early with honors from the University of Wisconsin-Madison, where he earned his Bachelor of Science in Biochemistry with a minor in Business. He pursued his Doctor of Medicine from Loyola University Chicago Stritch School of Medicine. During medical school, he was granted a leave of absence to be able to pursue a Masters of Business Administration from Emory University Goizueta Business School. His business education included concentrations in healthcare, strategy, and management, and he graduated Beta Gamma Sigma. He then returned to Chicago to complete his MD, graduating cum laude, Alpha Omega Alpha, and with an honor in research. Next, Dr. Menapace attended the University of Cincinnati for his orthopaedic surgery residency, where he also served as a chief resident at both the university and children’s hospitals. Now in his fellowship year, he is receiving advanced training in pediatric spine surgery. He has concentrated much of his research efforts on pediatric spine. His pediatric spine research now spans nearly a decade across three major children’s hospitals. His projects have included adolescent idiopathic scoliosis, skeletal dysplasia spinal pathology, syndromic scoliosis, neurofibromatosis, and neuromuscular scoliosis. He plans on an academic career in pediatric spine surgery, along with skeletal dysplasias, limb deformity, and trauma.

In Dr. Menapace’s opinion, reviewers should have good attention to detail. The ability to identify minor inconsistencies or shortcomings in papers can be very challenging. Reviewers should also be open. While some papers may publish on techniques or theories that are different from the reviewer’s personal preferences, these biases should not impact their evaluations. Lastly, reviewers should be dedicated. Researchers have frequently spent months or years putting together this project. They deserve a reviewer who is willing to dedicate significant time and effort into evaluating their publication.

From a reviewer’s perspective, Dr. Menapace highlights that institutional review board (IRB) approval is critical in protecting patients. The IRB serves as a voice for the patients. They function to ensure “primum non nocere” or “first, do no harm.” Their focus on safety, integrity, and quality should not be overlooked, and without them, these things may be omitted from research.

“Anyone who has submitted papers understands that performing the research is only half the work. Writing the paper and making edits at the reviewers request is also critically important. Therefore, it’s important that reviewers realize how major of a role they play in all of our research endeavors. And without them, the integrity and quality of research would be compromised,” says Dr. Menapace.

(by Lareina Lim, Brad Li)

Lakshmi N. Kurnutala

Dr. Lakshmi N. Kurnutala, MD, M.Sc., FASA, is the Professor & Director of Neuro-anesthesiology, Department of Anesthesiology, University of Mississippi Medical Center, Jackson, USA. His specialties focus on neuro anesthesiology, general anesthesiology, chronic pain management, and regional anesthesiology. His research areas and focuses are outcome research, cost effective analysis, basic research and pain medicine. In the last 9 years as a director of Neuro-anesthesiology and pain physician at UMMC, he implemented many protocols/guidelines to improve patient care, like anesthesia for awake craniotomy, sitting craniotomy, deep brain stimulation, enhanced recovery after spine surgery, anesthesia for LITT (Laser Interstitial Thermal Therapy) for brain tumors, epilepsy, and enhanced recovery for kidney transplant patients. Dr. Kurnutala served as a mentor for junior faculty, pain fellows, medical students, residents, and undergraduate students. In future, he would like to continue to improve as a physician, teacher, researcher and provide the best possible clinical care. Learn more about him here.

JSS: What are the limitations of the existing peer-review system? What can be done to improve it?

Dr. Kurnutala: Lack of mentorship is one of the major limitations for the peer-review system. Newer researchers and clinicians especially need to understand the ethical considerations of the peer-review system. Mentorship helps both mentor and mentee to improve in different areas in the research. Keeping the authors and reviewers anonymous (double blinding) helps the reviewers to do better review with no bias.

JSS: What reviewers have to bear in mind while reviewing papers?

Dr. Kurnutala: Reviewers need to understand how they are going to affect the future of medicine similar to the researchers. The researchers work hard to put their research idea on the paper, prepare the protocol, go through the IRB approval, completing the research, analyzing the data, and finally drafting the paper. Reviewers pay attention to every detail of the paper to give the best possible review. If they do not have the related expertise, they would better decline to review the paper. That gives the opportunity for the researchers to get better reviewer to review their work.

JSS: Data sharing is prevalent in scientific writing in recent years. Do you think it is crucial for authors to share their research data?

Dr. Kurnutala: Yes, data sharing helps to understand other researchers across the world to analyze and learn about the research project. But researchers need to understand who the owner of the data is, and what data they can share with others without affecting the confidentiality of the study participants.

(by Lareina Lim, Brad Li)

Takeshi Oki

Dr. Takeshi Oki, MD, PhD, is the Chief of Orthopedic Surgery Department, in Yuki Hospital, Ibaraki, Japan. He graduated from Showa University School of Medicine in 1996. Since 2001, he worked as the Orthopedic Surgeon in Yuki Hospital. From 1996-2000, he was a resident at Showa University Fujigaoka Hospital. He was the traveling fellow from 2011 to 2012 in Hopital Neurologique (Lyon, France), Emory University Spine Center (Atlanta, USA), and Institut Mutualiste Montsouris (Paris, France).

Dr. Oki indicates that in the scientific field, criticism from an objective perspective is thought to flexibly expand research thinking that is biased toward self-centeredness. In his opinion, while doing peer review, reviewers are required to evaluate the researcher's thinking process rather than the research content.

In addition, from the perspective of a reviewer, Dr. Oki thinks that institutional review board (IRB) approval is useful for organizing and disclosing researchers' thought processes. If this process is omitted, there is a risk that research thinking will become even more self-centered.

(By Lareina Lim, Brad Li)

December, 2023

Andrew Y Powers

Dr. Andrew Powers, MD, MBI, is currently a neurosurgery resident at Beth Israel Deaconess Medical Center / Boston Medical Center at Harvard Medical School. He is a graduate of Brown University’s combined BA/MD Program in Liberal Medical Education with undergraduate concentrations in mathematics, philosophy, and biology. During residency, he completed a master’s in biomedical informatics at the Blavatnik Institute at Harvard Medical School. His research interests focus on clinical and financial outcomes in spine surgery, with a special interest in statistical analysis and machine learning.

JSS: What are the limitations of the existing peer-review system?

Dr. Powers: Many journals do not review rigorously the statistical methods used in published papers, leading to the propagation of invalid results. Every paper should be reviewed by at least one independent researcher with statistical expertise.

JSS: Peer reviewing is often anonymous and non-profitable, what motivates you to do so?

Dr. Powers: I enjoy the “meta-analysis” of statistical methods. The often retrospective, low-quality, low-quantity data available in much of surgical research requires careful analysis to draw meaningful conclusions. I hope through peer review to contribute to raising analytic standards in medical research.

JSS: Data sharing is prevalent in scientific writing in recent years. Do you think it is crucial for authors to share their research data?

Dr. Powers: I do think it is crucial for authors to share their raw data when able. There are often many approaches to data analysis, involving choices regarding data collection, variable definitions, population inclusion/exclusion criteria, as well as the actual statistical assumptions and tests used. Previous research has demonstrated that, even among “reasonable methods,” inconsistent conclusions may be drawn depending solely upon the chosen methods. While there are many practical and legal limitations to data sharing in a medical context, this would allow for independent researchers to reproduce and evaluate how sensitive a study’s findings are to variations in the statistical approach used.

(by Lareina Lim, Brad Li)