Health Disparities of Spinal Surgery and Injections by Race

Introduction: Musculoskeletal spinal pain is one of the leading causes of disability worldwide, and consistently ranks as one of the largest healthcare expenditures within the US. Racial disparities in medical care have previously been pronounced within the US population but efforts have been made to decrease this occurrence. We aimed to evaluate the current incidence of spinal surgery (SpS) and spinal injection (SpI) by race within the Florida population. SpS was separated into fusion and non-fusion surgery based on CPT codes by a trained neurosurgeon.

Methods: De-identified patient records were requested from the OneFlorida Research Consortium for patients with diagnosed spinal pain who underwent SpI or SpS between 2012-2022. Steel-Dwass and odds ratio (OR) were used to analyze the data (JMP Pro 17). Median[Q15,Q85] and effect size are reported due to non-normal distributions.

Results: 12,450 patients (54.5% female, White: 74.9%, Black: 20.1%; ‘other’ minority (OM): 5.1%) were identified. White and OM underwent SpI or SpS quicker (White/OM: 2[0,7] years) than Black (4[1,7] years). Black and OM had longer wait to fusion surgery when initial procedure was SpI (Black: 1.5[1,5], OM: 3 [1,6] years) than White (1[1,3] years). Black had a greater number of SpI (1[0,2]) than White (1[0,1]). All effect sizes were mild. SpS was more likely to occur as the first procedure in White than Black (OR: 1.6[1.4,1.8], p< 0.0001) or OM (OR: 1.2[1.1,1.5], p=0.005).

Conclusion : Racial disparities may persist within SpS and SpI related to musculoskeletal spinal pain within the Floridian population. A higher number of SpI and increased time to fusion surgeries may represent persisting bias in healthcare for Black patients. Insurance coverage and barriers to access may be additional factors to consider. Florida’s racial distribution is similar to the US and may represent persisting health disparities nationwide.