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Growth of Spinal Interventional Pain Management Techniques: Analysis of Utilization Trends and Medicare Expenditures 2000 to 2008

Manchikanti, Laxmaiah MD*,†; Pampati, Vidyasagar MSc*; Falco, Frank J. E. MD‡,§; Hirsch, Joshua A. MD

doi: 10.1097/BRS.0b013e318267f463
Health Services Research

Study Design. Analysis of the growth, utilization trends, and Medicare expenditures of spinal interventional pain management techniques from 2000 through 2008.

Objective. To evaluate the use of epidural steroid injections, facet joint interventions, and sacroiliac joint interventions, and to analyze the trends of Medicare utilization and expenditures in multiple settings—namely, hospital outpatient departments, ambulatory surgery centers, and physician offices.

Summary of Background Data. There has been an explosive growth of many invasive and noninvasive modalities designed to manage chronic spinal pain. Commonly used interventional techniques include epidural steroid injections, facet joint interventions, and sacroiliac joint interventions. However, their effectiveness and the appropriateness of their application continue to be debated.

Methods. The present article provides an analysis of the growth of spinal interventional techniques, as described earlier, for managing the chronic spinal pain of Medicare beneficiaries from 2000 through 2008. The standard 5% national sample of the Centers for Medicare and Medicaid Services carrier claims that record data from 2000 through 2008 were utilized. Current procedural terminology codes from 2000 through 2008 were used to identify the number of procedures performed each year, as well as trends and expenditures.

Results. Medicare recipients receiving spinal interventional techniques increased 107.8% from 2000 through 2008, with an annual average increase of 9.6%, whereas spinal interventional techniques increased 186.8%, an annual average increase of 14.1% per 100,000 beneficiaries.

Conclusion. The study suggests explosive increases in spinal interventional techniques from 2000 to 2008, with some slowing of growth in later years.

An analysis of the growth of spinal interventional techniques in managing the chronic spinal pain of Medicare beneficiaries was performed for the years 2000 through 2008. The overall costs increased in all settings, but the study suggests that there has been a slowdown in the growth of spinal interventional techniques.

*Pain Management Center of Paducah, Paducah, KY

Anesthesiology and Perioperative Medicine, University of Louisville, Louisville, KY

Mid Atlantic Spine & Pain Physicians of Newark, Newark, DE

§Temple University Hospital, Philadelphia, PA; and

Departments of Radiology and Neurosurgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA.

Address correspondence and reprint requests to Laxmaiah Manchikanti, MD, 2831 Lone Oak Rd, Paducah, KY 42003; E-mail:

Acknowledgment date: January 18, 2012. First revision date: May 14, 2012; Second revision date: June 21, 2012. Acceptance date: July 2, 2012.

The manuscript submitted does not contain information about medical device(s)/drug(s).

American Society of Interventional Pain Physicians funds were received to support this work.

One or more of the author(s) has/have received or will receive benefits for personal or professional use from a commercial party related directly or indirectly to the subject of this manuscript: for example, honoraria, gifts, consultancies, royalties, stocks, stock options, decision-making position.

© 2013 Lippincott Williams & Wilkins, Inc.