Socioeconomic Status Among Elderly Adults with Spinal Deformity Undergoing Thoracolumbar Correction

Introduction: Prior studies examining the relationship between socioeconomic status (SES) and spinal deformity have shown minimal relation but were mostly limited to pediatric populations with distinct pathophysiology from adult cases. We hypothesize that patients undergoing deformity correction, and those experiencing complications post-operatively will have a higher national area deprivation index (ADI) score.

Methods: We reviewed radiographic and outcome data of 116 thoracolumbar fusion patients over 65 years of age between 2015 and 2024. Demographic information and postoperative outcomes were collected. The ADI was evaluated via the Neighborhood Atlas®, a validated measure of US geographic socioeconomic conditions. These scores are reported as a percentile, with higher scores representing greater socioeconomic disadvantage.

Results: Our cohort included 79 females (68.1%). Average age and BMI were 70.9 + 4.3 years and 28.9 + 5.4. 108 patients were white, 7 black, and 1 Asian. 12 patients (10.3%) developed proximal junction failure and 32 (27.6%) reported persistent back pain at their latest follow-up appointment.

The average national ADI score among this cohort was 59.19 + 25.5% (p < 0.001). ADI score was not normally distributed in this cohort (p < 0.001). Average ADI of white and black patients were 58.8 + 25.3 and 71.9 + 23.7% respectively (p=0.16).

No significant differences in national ADI percentiles were found when comparing patients who did and did not develop PJF (60.2% non-PJF vs 50.6% PJF, p=0.257) or persistent back pain (60.2% no back pain vs 56.0% back pain, p=0.42).

Conclusion : The average patient is more disadvantaged than the average United States habitant. Univariate analysis revealed no significant difference in the socioeconomic status of adult spinal deformity patients based on development of PJF, back pain, suggesting that SES has minimal effect on complication rates. The distribution of SES is not statistically different by race in this cohort, though limited by sample size.