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Low- and middle-income countries contribute to only a small percentage of publications in multiple medical fields. Editorial bias was reported to be an important reason for this. However, whether this trend exists in leading spine journals remains unclear. This study determined the composition of the editorial boards of leading spine journals and analyzed the international representation of editorial boards.The editorial board members of four leading subspecialty spine journals, including The Spine Journal, Journal of Neurosurgery: Spine, European Spine Journal, and Spine were identified from the journals' websites. The countries of editorial board members were identified and analyzed according to the continent and country income categories classified by the World Bank.A total of 608 editorial board members were identified from the four leading spine journals. The majority (91.4%) of editorial board members were from high-income countries, followed by upper-middle income countries (7.2%), and lower-middle income countries (1.3%). No editorial board members were from low-income countries. Regarding the continent of residence, 46.5% of the editorial board members were from North America, followed by Europe (38.5%), Asia (9.9%), South America (2.8%), Oceania (1.6%), and Africa (0.7%). The editorial board members came from 40 different countries, which were concentrated in North America, Western Europe, and East Asia. The largest number of editorial board members came from the United States (42.3%), followed by Germany (6.9%), the United Kingdom (6.7%), Switzerland (5.8%), and Italy (5.1%).A lack of international representation on editorial boards exists in leading spine journals. Editorial board members from high-income countries are substantially overrepresented, while editorial board members from low- and middle-income countries are severely underrepresented. The United States is the most represented country on the editorial boards of leading spine journals.

How international are the editorial boards of leading spine journals? A STROBE-compliant study