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Updated: Jun 21, 2025
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Paradigms of Lower Extremity Electrical Stimulation Training After Spinal Cord Injury
Published on: February 1, 2018
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Spinal Cord Stimulator Inequities Within the US Military Health System
Ysehak Wondwossen1, Michael S Patzkowski2, Maxwell Y Amoako3
1School of Medicine, Uniformed Services University, Bethesda, MD, USA.
Summary
Black patients receive spinal cord stimulation (SCS) less often than White patients. White patients try fewer treatments before SCS, while Black patients do not show this pattern, indicating a need for equitable care pathways.
Area of Science:
- Health Services Research
- Health Equity
- Pain Management
Background:
- Studies show racial inequities in spinal cord stimulation (SCS) access.
- Lack of data on system-level changes to promote health equity in SCS.
- This study investigates treatment exhaustion prior to SCS among racial groups.
Purpose of the Study:
- To evaluate if Black patients exhaust more treatment options than White patients before receiving SCS.
- To identify potential system-level factors contributing to SCS disparities.
Main Methods:
- Retrospective cohort study of US Military Health System data (2017-2020).
- Included Black and White patients with persistent spinal pain syndrome (PSPS) post-back surgery.
- Generalized linear model analyzed SCS receipt predictors, including race and treatment types.
Main Results:
- Black patients (10.3%) were less likely to receive SCS than White patients (13.6%).
- Significant interaction: White patients with 0-3 treatments were more likely to get SCS than Black patients with 0-3 treatments.
- Likelihood of SCS was similar for Black and White patients who tried >3 treatments.
Conclusions:
- White patients with PSPS tried fewer treatments before SCS compared to Black patients.
- Treatment number was not significantly related to SCS receipt for Black patients.
- Findings suggest a need for structured referral pathways and equity-focused provider evaluations.
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