Letter to the editor concerning "characteristics of baseline frequency data in spinal RCTs do not suggest widespread non-random allocation" by MMS Levayer, et al. (Eur Spine J; 2023; 32: 3009-3014)

Levayer and colleagues looked for non-random baseline data from 167 randomized controlled trials (RCTs) in 4 spine journals, concluding that there was no evidence of ‘systemic fraudulent behaviour’ [1]. The authors should be congratulated for such a major undertaking and making data available with their publication. However, fraud is merely a subset of compromised publication integrity [2]. There are reasons to be cautious about the integrity of publications within the spine journal dataset.