Assessing the State of Racial Disparities Literature in Spine Surgery: A Call for Action

Introduction: Previous literature has demonstrated worse outcomes amongst individuals from racial and ethnic minority groups that receive spine surgery. This study aims to assess the evidence on racial disparities within spine surgery with a specific goal of quantifying the distribution of articles devoted to either identifying, understanding, or reducing disparities.

Methods: The authors searched the MEDLINE, Embase, and Scopus databases from inception to present using keywords to represent the concepts of neurosurgery, patients, racial disparities, and specific study types. Two independent reviewers screened the article titles and abstracts for relevance. A third reviewer resolved conflicts. Data were then extracted from the included articles and each article was categorized into one of three phases: identifying, understanding, or reducing disparities. This review was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines.

Results: One-hundred and fifty-five studies were included. Most studies included both neurosurgical and orthopedic patients (83.9%). Most studies were dedicated to identifying racial disparities (90.3%). Only 8.4% of studies were devoted to understanding disparities and no studies offered interventions to reduce disparities. Black patients were the most negatively impacted racial/ethnic group in the review with 68.4% of studies reporting a race-based disparity. Complications, offering of treatment, length of stay, and readmission rates were the most frequently measured outcomes.

Conclusion : While there has been a rise in the literature dedicated to racial disparities in spine surgery, the majority is in the identification phase. Further work is needed to better understand and ultimately reduce these disparities in order to provide more equitable care for patients suffering from spinal disease.