Social determinants of health and outcomes after spinal cord stimulation: a retrospective cohort study

Background and objectives Social needs may influence longitudinal care after spinal cord stimulation (SCS), but their relationship to trial and post-implant outcomes is uncertain. We examined associations between cumulative social determinants of health burden and SCS outcomes. Methods We retrospectively studied adults identified through chart review of SCS-related procedure records at three centers in a single health system from 2021 to 2024. Five electronic health record social-need domains (transportation, food, housing, utilities, and intimate partner violence) were assessed and patients were grouped as having 0, 1, or ≥2 positive domains. Outcomes included trial-to-implant conversion, post-implant pain and response, longitudinal pain, adverse events, and documented loss of efficacy. Results Among 407 patients, 322 had 0 positive domains, 55 had 1, and 30 had ≥2. Trial-to-implant conversion was similar across groups (78.0%, 80.0%, and 76.7%; p=0.925). Among 317 patients with post-implant pain data, sustained response occurred in 51.6%, 47.7%, and 21.7% (p=0.023). In adjusted analysis, patients with ≥2 positive domains, compared with those with no documented social needs, had 75% lower odds of achieving ≥50% pain relief at last follow-up (OR 0.25, 95% CI 0.09 to 0.75), pain scores 1.26 points higher (95% CI 0.45 to 2.08), and pain relief 14.13 percentage points lower (95% CI −23.68 to −4.58). In an exploratory full-cohort analysis, period-adjusted probabilities of documented ≥50% relief were 55.1%, 42.1%, and 33.3% (p=0.003). Conclusions Patients with multiple documented social needs had substantially worse post-implant outcomes despite similar SCS trial-to-implant conversion. While these observational findings identify an association with longer-term SCS outcomes, they do not establish that social needs necessarily cause reduced SCS efficacy.