Sociodemographic Variables Are Rarely Reported in Randomized Controlled Trials Investigating Posterior Spinal Fusion For Adolescent Idiopathic Scoliosis: A Systematic Review

Introduction: Adolescent Idiopathic Scoliosis (AIS) is a three-dimensional structural spinal deformity that affects children from the age of ten until skeletal maturity. Untreated AIS can lead to significant physical deformity, as well as psychosocial and medical morbidity. Surgical intervention, particularly posterior spinal fusion (PSF), is considered when conservative treatment fails. Demographic and sociodemographic variables influence AIS care, yet their reporting in randomized controlled trials (RCTs) remains unclear. The purpose of this study is to determine the rate of reporting of demographic and sociodemographic variables in RCTs investigating PSF for AIS.

Methods: Following PRISMA guidelines, PubMed, Embase, and Scopus databases were searched using the terms “posterior spinal fusion,” “randomized controlled trial,” and “adolescent idiopathic scoliosis.” Inclusion criteria were RCTs on PSF in AIS, published in English, with accessible full texts. Exclusions included non-English publications, cadaver studies, technique articles, and non-RCT designs. Two authors screened studies for inclusion, resolving disagreements with a third author. Data collection involved recording the presence of variables like age, sex, race, ethnicity, insurance status, household income, housing status, and education level. Descriptive statistics, chi-squared tests, and Fisher's exact tests were used for analysis.

Results: The initial search identified 148 studies; 44 met inclusion criteria. Demographic variables such as age and sex were reported in 97.7% and 95.5% of studies, respectively. Sociodemographic variables including race and ethnicity were reported in 6.8% and 9.1% of studies, respectively. Sociodemographic variables like household income, insurance, housing, and education were absent in all studies. There was a significant disparity in the reporting of demographic versus sociodemographic variables (P <.001). No significant differences were observed in sociodemographic variable reporting by journal (P=0.999) or year of publication (P=0.185), although a trend towards increased reporting post-2017 was noted.

Conclusion : This systematic review highlights the under-reporting of sociodemographic variables in RCTs on PSF for AIS, with demographic factors like age and sex more frequently reported. Despite the significance of sociodemographic factors in patient care, their inclusion in RCTs remains limited. Improved reporting of these variables is essential for assessing pre-operative and post-operative outcomes, ultimately enhancing AIS patient care. Future research should prioritize comprehensive demographic and sociodemographic data to ensure equitable healthcare outcomes.