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Adolescent Idiopathic Scoliosis Care in an Underserved Inner-City Population: Screening, Bracing, and Patient- and Parent-Reported Outcomes

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Abstract

Study Design

Retrospective review of a prospectively collected database.

Objectives

This preliminary investigation sought to identify the quality of care adolescent idiopathic scoliosis (AIS) patients from our large, underserved community had received before presenting at this institution’s clinic.

Summary of Background Data

AIS affects 1% to 4% of children between ages 10 and 16. Barriers to health care for patients in underserved populations have not been well studied.

Methods

Patients who visited a single surgeon’s clinic for primary AIS between June 2016 and January 2017 were enrolled. Patients had 36-inch full-spine radiographs and completed a survey of demographics, prior AIS care received (screening, bracing, etc), socioeconomic parameters, and patient-reported outcomes (PROs; Scoliosis Research Society [SRS]-30 Questionnaire and Body Image Disturbance Questionnaire [BIDQ]). Parametric and nonparametric analyses were used and percentages and mean/median values were reported.

Results

47 patients (age: 15 ± 3 years; 82.7% female) were included. Overall, 25.5% of patients reported a family history of scoliosis, and 42.6% had no prior knowledge of scoliosis. Per Scoliosis Research Society (SRS) recommendations, 15 patients required observation (main Cobb angle: <25°), 22 patients were eligible for bracing (25°–45°), and 10 patients were surgical candidates (>45°). In addition, 21.3% of all patients were never screened for scoliosis; of these, 50% had a main scoliosis curve >25°. Seventy percent of surgical candidates never wore a brace, and 59.3% of screened patients who were eligible for bracing were not braced at initial presentation. Patients who were left unbraced when eligible exhibited worse BIDQ scores (1.7 vs. 1.4, p < .05).

Conclusions

One of five children in our population was never screened for scoliosis, and nearly three of five children did not receive optimal care as recommended by SRS. AIS patients in our inner-city populations are potentially at risk of continuing to experience a significant disadvantage in health care access.

Level of Evidence

Level IV case series.

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Authors and Affiliations

  1. Department of Orthopaedic Surgery and Rehabilitation Medicine, State University of New York (SUNY), Downstate Medical Center, 450 Clarkson Ave, Brooklyn, NY, 11203, USA

    Bassel G. Diebo MD, Frank A. Segreto BS, James C. Messina BS, Karen Paltoo BA, Steven A. Burekhovich BS, Lee R. Bloom MD, Frank S. Cautela BS, Neil V. Shah MD, MS & Carl B. Paulino MD

  2. Saint George’s University School of Medicine, True Blue, Grenada

    Maximillian Solow MD

  3. Division of Spine Surgery, NYU Langone Orthopedic Hospital, 301 E 17th St, New York, NY, 10003, USA

    Peter G. Passias MD

  4. Spine Service, Hospital for Special Surgery, 535 E 70th St, New York, NY, 10021, USA

    Frank J. Schwab MD & Virginie Lafage PhD

  5. Division of Orthopaedic Surgery, The Children’s Hospital of Philadelphia, 3401 Civic Center Blvd, Philadelphia, PA, 19104, USA

    Saba Pasha PhD

Authors
  1. Bassel G. Diebo MD
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  2. Frank A. Segreto BS
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Corresponding author

Correspondence to Bassel G. Diebo MD.

Additional information

Author disclosures: BGD (none), FAS (none), MS (none), JCM (none), KP (none), SAB (none), LRB (none), FSC (none), NVS (none), PGP (personalfees from Medicrea and SpineWave; nonfinancial support from Zimmer Biomet; personal fees from CSRS, outside the submitted work), FJS (grants from DePuy Spine, NuVasive, Stryker, and K2M; personal fees from ZimmerBiomet, Medtronic, NuVasive, K2M, and Medicrea; other from Nemaris Inc., outside the submitted work), SP (grants from Scoliosis Research Society, Pediatric Orthopedics of North America, outside the submitted work), VL (grants from DePuy Spine, NuVasive, K2M, Stryker, NASS, and SRS; personal fees from DePuy Spine and AO Spine; other from Nemaris Inc., outside the submitted work), CBP (personal fees fromDePuy Synthes, outside the submitted work).IRB approval: SUNY Downstate Medical Center IRB Approval Number: 315242-4.

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Diebo, B.G., Segreto, F.A., Solow, M. et al. Adolescent Idiopathic Scoliosis Care in an Underserved Inner-City Population: Screening, Bracing, and Patient- and Parent-Reported Outcomes. Spine Deform 7, 559–564 (2019). https://doi.org/10.1016/j.jspd.2018.11.014

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