ArticleSpine deformity2026
Removing race from pulmonary function tests in children with idiopathic scoliosis.
Article in Spine deformity, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Authors and funding
7 authors.
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Abstract
purposeTo evaluate the impact of switching from race-specific to race-neutral pulmonary function tests (PFT) equations in Black versus White children with idiopathic scoliosis according to 1) a minimum clinically important difference (MCID: > 10%) in forced vital capacity percent predicted (FVC%); 2) between-group differences in achieving normal lung function (FVC ≥ 80%); and 3) greater FVC% changes from race-specific to race-neutral than changes from surgery after 2 years.
methodsThis single-institution retrospective review in the southwestern United States included the PFTs of 1413 (314 Black, 1099 White) children 14.4 ± 2.2 years with idiopathic scoliosis. Curves averaged 63° before spinal fusion between 2002 and 2024; 550 had 2-year follow-up. PFTs were recalculated using race-specific and race-neutral equations.
resultsPreoperatively, race-specific equations showed similar FVC% between groups (86% Black vs. 84% White). Recalculating with race-neutral equations shifted Black FVC% downward by 8% and White FVC% upward by 5%, creating a 14% between-group difference exceeding the MCID. Under race-neutral equations, the proportion of Black children achieving "normal" lung function (FVC ≥ 80%) dropped from 66 to 44%, while White children increased from 63 to 74%. Shifting from race-specific to race-neutral equations resulted in a larger change in FVC% than the actual physiological change measured two years post-fusion.
conclusionIn children with idiopathic scoliosis requiring fusion, race-specific PFTs overestimate FVC% in Black children and underestimate FVC% in White children, resulting in clinically important differences. Adopting race-neutral PFT equations prevents overestimating lung function in Black children with scoliosis, promoting more equitable, accurate assessments.
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