Descriptive Analysis of Spinal Neuroaxial Injections, Surgical Interventions and Physical Therapy Utilization for Degenerative Lumbar Spondylolisthesis within Medicare Beneficiaries from 2000-2011.

Available online from MWHC library: 1996 - present, Available in print through MWHC library: 1999 - February 2003

CONCLUSION: Interventional techniques and physical therapy are frequently used treatment modalities for symptomatic degenerative spondylolisthesis. Understanding utilization of these techniques is important to determine relative clinical efficacies and to optimize future health care expenditures.

LEVEL OF EVIDENCE: N/A.

METHODS: This study utilized the 5% national sample of Medicare carrier claims from 2000 through 2011. A cohort of beneficiaries with a new ICD-9 diagnosis code for degenerative lumbar spondylolisthesis was identified. Current procedural terminology codes were used to identify the number of procedures performed each year by specialty on this cohort.

OBJECTIVE: To determine the utilization of various treatment modalities in the management of degenerative spondylolisthesis within Medicare beneficiaries.

RESULTS: A total of 95,647 individuals were included in the analysis. Average age at the time of initial diagnosis was 72.8 +/- 9.8 years. Within this study cohort, spondylolisthesis was more prevalent in females (69%) than males and in Caucasians (88%) compared to other racial demographics. Over 40% of beneficiaries underwent at least one injection, approximately one third (37%) participated in physical therapy, one in five (22%) underwent spinal surgery, and one third (36%) did not utilize any of these interventions. Greater than half of all procedures (124,280/216,088) occurred within 2 years of diagnosis. The ratio of focal interventions (transforaminal and facet interventions) to lessselective (interlaminar) procedures was greater for the specialty of Physical Medicine and Rehabilitation compared to the specialties of Anesthesiology, Interventional Radiology, Neurosurgery, and Orthopedic Surgery. The majority of physical therapy was dedicated to passive treatment modalities and range of motion exercises rather than active strengthening modalities within this cohort.

STUDY DESIGN: Retrospective, observational study.

SUMMARY OF BACKGROUND DATA: Degenerative lumbar spondylolisthesis is a condition often identified in symptomatic low back pain. A variety of treatment algorithms including physical therapy and interventional techniques can be used to manage clinically significant degenerative spondylolisthesis.

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