Study Finds Higher Rates of Complications Following Scoliosis Surgery in Teens Due to Disparities


Socioeconomic, racial, and insurance disparities impact individuals' health before and after receiving surgery to treat adolescent idiopathic scoliosis.

Teens that are Black, publicly insured, and of lower socioeconomic status (SES) were reported to have more extensive complications following surgery to treat adolescent idiopathic scoliosis (AIS), according to research conducted by Nemours Children’s Health in a retrospective cohort study.

Kid with scoliosis, isolated on white background - Image credit: Jeffy1139 |

Image credit: Jeffy1139 |

“The greatest disparities in care existed between patients who are Caucasian, privately insured, and of higher socioeconomic status and those who are Black, publicly insured, and of lower socioeconomic status,” said Suken A. Shah, MD, senior author, Pediatric Orthopedic Surgeon and the Shands/MacEwen Endowed Chair of Orthopedics and Chair of the Department of Orthopedic Surgery at Nemours Children’s Health, Delaware Valley, in a press release. “Our results suggest that these patient characteristics have a clear influence on pre- and post-operative care and, most concerningly, on post-surgical outcomes.”

Individuals with scoliosis experience an abnormal side-side curve in their spine, that develops an S or C shape. The press release noted that children develop scoliosis at 10 to 15 years old, although younger cases can occur. If the development is severe, the individuals could face joint damage, arthritis, lung problems and pain. SES is the most common form of scoliosis, and those that have a worsening condition could receive a back brace or surgery to prevent decline, based on the severity.

The study included 421 individuals that were 10 to 21 years old with AIS. Out of the 421 individuals, 74% were Caucasian, 16% were Black, and 9.4% were other racial or ethnic backgrounds. A reported 80% were covered with private insurance and 20% had public insurance. All the individuals received posterior spinal fusion (PSF) surgery at a pediatric institution from 2015 to 2021.

However, the researchers found that if an individual was Black, of lower SES, and had public insurance, they had a lower chance of being prescribed a back brace or given a second opinion prior to receiving PSF surgery to treat AIS.

The press release provided data to support the research, including that 36% of Black individuals were likely to be treated with a back brace for their AIS, compared to 60% of Caucasian individuals. Similarly, 8.7% of Black individuals received a second opinion, compared to 26% of Caucasian individuals. If an individual had public insurance, they were also less likely to receive a back brace or second opinion, at 45% and 9.4%, respectively, for public insurance, and 57% and 26%, respectively, for private. Only 31% of individuals of low SES were prescribed a back brace, compared to 55% of individuals of high SES.

The researchers found that 31% of individuals of low SES missed a post-operative checkup, compared to 13% of individuals of high SES.

“Missed appointments are concerning because pre-operative assessments offer opportunities to optimize treatment and educate patients about procedures, including non-surgical options and research study enrollment,” said Shah, in a press release “Post-operative appointments allow for potential changes to the treatment plan and for early detection and treatment of any complications, to avoid potentially more significant complications when treatment is delayed.”

However, the researchers believe that a set of reminders or telemedicine visits could help prevent a missed appointment for individuals that are more likely be a no show.

The findings suggest that socioeconomic, racial and insurance disparities impact individual health before and after receiving surgery to treat AIS.


Black & low-income teens have more ED visits, major complications after scoliosis surgery. EurekAlert!. News release. October 23, 2023. Accessed November 8, 2023.

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