{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,29]],"date-time":"2026-03-29T08:01:43Z","timestamp":1774771303619,"version":"3.50.1"},"reference-count":28,"publisher":"Journal of Neurosurgery Publishing Group (JNSPG)","issue":"6","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2024,12,1]]},"abstract":"<jats:sec>\n<jats:title>OBJECTIVE<\/jats:title>\n<jats:p>Myelomeningocele (MMC) is a lifelong condition requiring complex multidisciplinary management. Using the National Spina Bifida Patient Registry (NSBPR), the authors tested the association between sociodemographic variables and odds of undergoing neurosurgical procedures.<\/jats:p>\n<\/jats:sec>\n<jats:sec>\n<jats:title>METHODS<\/jats:title>\n<jats:p>The authors extracted sociodemographic, clinical, and neurosurgical procedure data on participants with MMC aged \u2265 1 year who visited an NSBPR clinic between 2009 and 2020. The zip code of the participant\u2019s residence at the time of the last spina bifida clinic visit was linked to the Distressed Communities Index (DCI) tier. Multivariate models were built to identify factors associated with undergoing CSF diversion, shunt revision, tethered cord release (TCR), and Chiari decompression.<\/jats:p>\n<\/jats:sec>\n<jats:sec>\n<jats:title>RESULTS<\/jats:title>\n<jats:p>There were 7924 participants with a median visit age of 13 years (IQR 7\u201320 years); 49.1% were male, 30.2% were non-Hispanic Black or Hispanic, 54.5% had public\/supplemental insurance, and 16.9% were from distressed communities. CSF diversion, shunt revision, TCR, and Chiari decompression were performed in 81.8%, 47.7%, 22.9%, and 8.7% of participants, respectively. In multivariate analyses controlling for age, sex, insurance, DCI tier, lesion level, and surgical closure timing, Hispanic individuals were less likely than their non-Hispanic White counterparts to undergo shunt revision (p = 0.013). Non-Hispanic Black and Hispanic individuals were less likely to undergo TCR (p &lt; 0.001 each) or Chiari decompression (p &lt; 0.001 each). Compared with privately insured individuals, publicly insured individuals were more likely to undergo CSF diversion (p = 0.031). Those in distressed communities had increased odds of undergoing CSF diversion (p = 0.004) than those in prosperous communities.<\/jats:p>\n<\/jats:sec>\n<jats:sec>\n<jats:title>CONCLUSIONS<\/jats:title>\n<jats:p>Among individuals with MMC participating in the NSBPR, there were differences in receiving neurosurgical procedures by race\/ethnicity, insurance type, and DCI tier. Additional prospective studies are necessary to elucidate the reasons for these variations and their impact on long-term outcomes for this patient population in order to created targeted interventions.<\/jats:p>\n<\/jats:sec>","DOI":"10.3171\/2024.7.peds24159","type":"journal-article","created":{"date-parts":[[2024,10,5]],"date-time":"2024-10-05T02:22:48Z","timestamp":1728094968000},"page":"601-609","source":"Crossref","is-referenced-by-count":2,"title":["Association between social determinants of health and select neurosurgical procedures in the National Spina Bifida Patient Registry"],"prefix":"10.3171","volume":"34","author":[{"given":"Maria A.","family":"Punchak","sequence":"first","affiliation":[{"name":"Department of Neurosurgery, University of Pennsylvania Health System, Philadelphia, Pennsylvania;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Stephen","family":"Miranda","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, University of Pennsylvania Health System, Philadelphia, Pennsylvania;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Canada","family":"Montgomery","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, University of Pennsylvania Health System, Philadelphia, Pennsylvania;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ena","family":"Agbodza","sequence":"additional","affiliation":[{"name":"Center for Data Driven Discovery in Biomedicine (D3B), Children\u2019s Hospital of Philadelphia, Pennsylvania;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Daksh","family":"Chauhan","sequence":"additional","affiliation":[{"name":"Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Amy","family":"Houtrow","sequence":"additional","affiliation":[{"name":"Department of Physical Medicine and Rehabilitation, University of Pittsburgh, Pennsylvania;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kathryn","family":"Smith","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, Keck School of Medicine, Children\u2019s Hospital Los Angeles, California;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Andrew B.","family":"Foy","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Medical College of Wisconsin, Milwaukee, Wisconsin;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jeffrey R.","family":"Leonard","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Nationwide Children\u2019s Hospital, Columbus, Ohio;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Heidi","family":"Castillo","sequence":"additional","affiliation":[{"name":"Developmental and Behavioral Pediatrics, Texas Children\u2019s Hospital\/Baylor College of Medicine, Houston, Texas;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jonathan","family":"Castillo","sequence":"additional","affiliation":[{"name":"Developmental and Behavioral Pediatrics, Texas Children\u2019s Hospital\/Baylor College of Medicine, Houston, Texas;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Rhonda G.","family":"Cady","sequence":"additional","affiliation":[{"name":"Health Services Research Program, Gillette Children\u2019s Hospital, St. Paul, Minnesota;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Robin M.","family":"Bowman","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Lurie Children\u2019s Hospital, Chicago, Illinois;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kurt A.","family":"Freeman","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, Institute on Development and Disability, Oregon Health & Science University, Portland, Oregon;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Brandon G.","family":"Rocque","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Children\u2019s of Alabama, Birmingham, Alabama; and"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Tracy M.","family":"Flanders","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, University of Pennsylvania Health System, Philadelphia, Pennsylvania;"},{"name":"Division of Neurosurgery, Children\u2019s Hospital of Philadelphia, Pennsylvania"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Gregory G.","family":"Heuer","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, University of Pennsylvania Health System, Philadelphia, Pennsylvania;"},{"name":"Division of Neurosurgery, Children\u2019s Hospital of Philadelphia, Pennsylvania"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1754","reference":[{"issue":"14","key":"b1","series-title":"Birth Defects Res","first-page":"947","article-title":"The National Spina Bifida Patient Registry: a decade\u2019s journey","volume":"111","author":"Castillo J","year":"2019","unstructured":"Castillo J, Lupo PJ, Tu DD, Agopian AJ, Castillo H. 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