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Burden of Sciatica on US Medicare Recipients

Maslak, Joseph P. MD; Jenkins, Tyler J. MD; Weiner, Joseph A. MD; Kannan, Abhishek S. MD; McCarthy, Michael H. MD, MPH; Hsu, Wellington K. MD; Patel, Alpesh A. MD, FACS

Journal of the American Academy of Orthopaedic Surgeons: September 09, 2019 - Volume Publish Ahead of Print - Issue - p
doi: 10.5435/JAAOS-D-19-00174
Research Article: PDF Only

Objective: This study evaluates the disease burden of sciatica on the US Medicare cohort.

Background Data: Sciatica is a common disability that has important physical, mental, and economic effects. The Medicare Health Outcomes Survey (HOS) is a demographic and outcomes survey used to monitor the performance of Medicare Advantage health plans in the United States. The HOS includes data on demographics, chronic medical conditions, and patient-reported outcomes.

Methods: Medicare HOS data for cohorts from 2007 to 2013 were obtained. Patients were placed into two categories based on the survey results: with or without a history of sciatica. Baseline demographics, chronic medical conditions, and physical health symptoms were aggregated. In addition, average VR-12 physical component summary and mental component summary scores were calculated for each group at baseline and at 2-year follow-up. A Fisher exact test was used to assess significance for categorical variables, and a t-test was used for continuous variables. VR-12 changes as small as 1 to 2 units have been found to be clinically and socially relevant.

Results: The baseline cohort data of 1,000,952 patients yielded 250,869 patients (25%) who reported the diagnosis of sciatica, compared with 750,083 patients (75%) without sciatica. Patients with a history of sciatica tended to be younger, less educated, and notably with more medical comorbidities. Physical component summary outcomes were approximately 8 units lower in the sciatica group at baseline and 7 units lower at 2-year follow-up. Mental component summary outcomes were 6 units lower in the sciatica group at baseline and 5 units lower at 2-year follow-up.

Conclusion: A large percentage of the US Medicare cohort suffers from symptomatic sciatica. Our study identified a 25% prevalence in the Medicare cohort. In addition, sciatica is associated with an increased incidence of comorbid medical conditions and poor health-related quality of life.

Level of Evidence: Level III

Study Design: Observational-Cohort Study

From the Department of Orthopaedic Surgery, Northwestern University, Chicago, IL (Dr. Maslak, Dr. Weiner, Dr. Kannan, Dr. McCarthy, Dr. Hsu, and Dr. Patel), and the Department of Orthopaedic Surgery, Emory Healthcare, Atlanta, GA (Dr. Jenkins).

Correspondence to: Dr. Maslak: jmaslak88@gmail.com

Dr. Hsu or an immediate family member has received IP royalties from Stryker; serves as a paid consultant to AlloSource, Bioventus, Medtronic Sofamor Danek, Mirus, NuVasive, Stryker, and Wright Medical Technology; has received research or institutional support from Medtronic; and serves as a board member, owner, officer, or committee member of Lumbar Spine Research Society and North American Spine Society. Dr. Patel or an immediate family member has received IP royalties from Alphatec Spine, Amedica, NuVasive, and Zimmer Biomet; serves as a paid consultant to Amedica, DePuy, Kuros Biosciences, NuVasive, and Zimmer Biomet; has stock or stock options held in Amedica, Cytonics, EndoLuxe, Nocimed, nView Medical, Tissue Differentiation Intelligence, and Vital5; and serves as a board member, owner, officer, or committee member of American Orthopaedic Association, AO Spine North America, Cervical Spine Research Society, International Society for the Advancement of Spine Surgery, Lumbar Spine Research Society, and North American Spine Society. None of the following authors or any immediate family member has received anything of value from or has stock or stock options held in a commercial company or institution related directly or indirectly to the subject of this article: Dr. Maslak, Dr. Jenkins, Dr. Weiner, Dr. Kannan, and Dr. McCarthy.

© 2019 by American Academy of Orthopaedic Surgeons
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