Sociodemographic variables are rarely reported in randomized controlled trials investigating posterior spinal fusion...

Adult spinal deformity (ASD) affects approximately 68% of patients over age 65 and can significantly reduce quality of life. Posterior spinal fusion (PSF) is a common corrective procedure, but sociodemographic disparities may influence outcomes. This study evaluates the frequency of sociodemographic variable reporting in randomized controlled trials (RCTs) investigating PSF for ASD, hypothesizing significant underreporting and their potential as modifiable confounders of treatment outcomes.

A systematic literature review was conducted on April 15, 2024, in accordance with PRISMA guidelines using PubMed, Embase, and Scopus to identify RCTs on ASD and PSF. Studies were included if they were full-length RCTs and excluded if non-English, unavailable, cadaveric, technical, or non-RCT. Two spine surgeons independently screened studies, with a third reviewer resolving disagreements. Data on demographic and socioeconomic variables were extracted. Descriptive statistics and chi-squared or Fisher's exact tests (P < 0.05) were used for analysis.

The search yielded 32 studies; after removing duplicates and ineligible studies, five RCTs published between 2008 and 2020 met inclusion criteria. All reported age and sex (100%), but none included race, ethnicity, employment, education, housing, or income, and only one reported insurance status (20%). Demographic and socioeconomic variables were significantly underreported compared to age and sex (P < 0.001), with no differences by journal or publication year.

Age and sex were consistently reported in ASD RCTs, but broader sociodemographic data were largely absent. Future trials should include these variables to better understand disparities and improve equitable care for ASD patients.