1453 - Functional and Pain Outcomes Three Months After Interventional Spine Procedures

To determine 3-month outcomes in disability, pain, and global health in patients following interventional spine procedures.

Design: A retrospective cohort study of 701 adults undergoing cervical ESI (CESI, n=323), lumbar ESI (LESI, n=58), transforaminal ESI (TFESI, n=181), SI joint injection (n=94), lumbar MBB (n=115), or lumbar RFA (n=82) was performed. PROs were collected pre-procedure and at 3 months post-procedure: Oswestry Disability Index (ODI), PROMIS Global Health-10 (PROMIS-10), Visual Analog Scale (VAS) for pain, and McGill Pain Questionnaire (MPQ). Unadjusted pre- and post tests were performed, and linear mixed-effects models (random patient intercept) provided adjusted timepoint effects controlling for age, sex, race, ethnicity, insurance, BMI, Charlson Comorbidity Index, depression, anxiety, PTSD, and smoking. 

Results: Adjusted 3-month disability improved and met MCID thresholds for CESI (−6.26, 95% CI −7.92 to −4.59; p< 0.001), LESI (−3.69, −6.86 to −0.53; p=0.023), TFESI (−5.26, −7.12 to −3.41; p< 0.001), SI (−6.03, −8.57 to −3.50; p< 0.001), and RFA (−4.87, −7.48 to −2.26; p< 0.001); LMBB showed a smaller change below MCID (−2.73, −4.85 to −0.60; p=0.012). Pain quality improved to a clinically meaningful degree across all procedures. In contrast, pain intensity decreased but was generally sub-MCID on the VAS. PROMIS-Physical increased modestly but remained below the MCID. PROMIS-Mental showed no time effect in any cohort. Across models, Medicaid, higher BMI, and current smoking were consistently associated with worse scores.

Conclusions: At 3 months, five of six procedures yielded clinically meaningful functional gains, and all procedures produced clinically meaningful improvements in pain quality. Average reductions in pain intensity and global health were smaller and typically below MCID. Socioeconomic disadvantage, obesity, smoking, and depression were independent correlates of poorer outcomes. Integrating social-risk mitigation, weight management, tobacco cessation, and behavioral health into procedural care may increase the proportion of patients who achieve clinically significant benefit.