Inclusion of Under-represented Minorities in Lumbar Spine Surgery Trials: Where Do We Stand?

Introduction: Chronic lower back pain due to degenerative lumbar spine disease (DLSD) is the second most common cause of disability among US adults. This study aims to evaluate the representativeness of US randomized controlled trials (RCTs) concerning surgery for DLSD.

Methods: A comprehensive literature search was performed to identify RCTs involving lumbar spine surgery. Random-effects model meta-analysis of pooled data was performed, with race, ethnicity, mental health, income, and worker’s compensation being our primary endpoints.

Results: Thirty-five studies yielding 21,762 patients with a mean age of 63.9 years, and a follow-up duration of 4 years were included. Male patients comprised 53% (95%CI: 49.6-56.4%). Ethnicity was reported as Non-Hispanic in 93.5% (95%CI: 90-96.3%). The most common race identified was white (83.6%, 95%CI: 80.8-86.1%), African-American comprised 6.27% (95%CI: 4.3-8.7%), while race was not reported in the remaining 7,830 participants. Mean BMI was 28.9, smokers comprised 16.2% (95%CI: 12.4-20.5%), and the mean Oswestry Disability Index score was 48.7. Patients with depression represented 11.7% (95%CI: 10.6-12.7%). Participants earning < $50,000 annually represented 45.5% (95%CI: 44.2-46.8%). Of the participants, 15.1% (95%CI: 8.9-22.7%) received worker’s compensation.

Conclusion : This meta-analysis showed a significant discrepancy regarding inclusion of non-white racial groups and Hispanic ethnicity within DLSD RCTs. While enrollment was not significantly different depending on income, insurance data are largely missing in RCTs.