Factors Associated with Presentation of Severe Adolescent Idiopathic Scoliosis

Abstract

Background: Adolescent idiopathic scoliosis (AIS) is a common referral to pediatric orthopaedic surgeons. Timely treatment with appropriate bracing decreases the risk of curve progression and need for surgical intervention. Despite pediatrician screening, patients still present to orthopaedic surgeons with curve magnitudes too large for nonoperative bracing to prevent progression to surgical curve magnitude. The aim of this study was to identify the sociodemographic differences between patients who are initially diagnosed with mild versus moderate/severe AIS.Methods: This retrospective cross-sectional study included patients aged 10 to 18 years diagnosed with AIS between 2011-2021 at a major metropolitan tertiary care center. Scoliosis severity was classified based on initial radiographs. Sociodemographic factors were recorded including patient addresses, which were cross-referenced with the diversitydatakids.org Child Opportunity Index (COI) database, which analyzes the quality of resources in a geographic area.Results: Gender, health insurance provider, race/ethnicity, and COI were all found to have a statistically significant relationship with Cobb angle (CA) and age at initial presentation. The odds of presenting with severe (versus mild and moderate) scoliosis were 2.3 times higher for patients who identified as Black/African American compared to those who identified as White. Additionally, the odds of initially presenting with severe scoliosis were almost 40% higher in females compared to males. Furthermore, each stepwise increase in COI was associated with a 17%-19% decrease in odds of presenting with severe scoliosis, depending on standardization.Conclusions: There are sociodemographic disparities in the identification and initiation of treatment for AIS. Specifically, the odds of presenting with severe scoliosis are increased in patients who identify as Black/African American or female and/or come from areas with lower access to resources (as defined by COI). Appropriate and timely referral to a pediatric orthopaedic surgeon for AIS treatment thus requires 1) educating primary care providers, pediatricians, and scoliosis screeners on how to appropriately identify scoliosis and the risks associated with late identification/referral and 2) public health initiatives, such as universal school screenings or outreach mobile clinics, to address access to care for patients at risk for late scoliosis identification.Level of Evidence: Level III (Retrospective cohort study).

Key concepts: •At the time of diagnosis, a patient's curve magnitude (calculated via Cobb angle) and future growth potential have significant implications in both curve progression and treatment planning.•Avoiding spinal fusion by early curve identification and appropriate nonoperative (i.e., brace) treatment reduces patient risk and healthcare spending.•There are sociodemographic disparities in the identification and initiation of treatment for adolescent idiopathic scoliosis.•The odds of presenting with severe scoliosis are increased in patients who identify as Black/African American or female and/or come from areas with a lower access to resources (as defined by the Child Opportunity Index).

Figure 1

Cobb angle calculation.