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

Sclafani, Joseph A., MD∗,‡; Constantin, Alexandra, PhD; Ho, Pei-Shu, PhD; Akuthota, Venu, MD; Chan, Leighton, MD

doi: 10.1097/BRS.0000000000001724

Study Design. A retrospective, observational study.

Objective. The aim of this study was to determine the utilization of various treatment modalities in the management of degenerative spondylolisthesis within Medicare beneficiaries.

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.

Methods. This study utilized the 5% national sample of Medicare carrier claims from 2000 through 2011. A cohort of beneficiaries with a new International Classification of Diseases 9th edition (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.

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%) than other racial demographics. Over 50% of beneficiaries underwent at least one injection, approximately one-third (37%) participated in physical therapy, one in five (21%) 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 less selective (interlaminar) procedures was greater for the specialty of Physical Medicine and Rehabilitation than for 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.

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

Medstar Georgetown University/National Rehabilitation Hospital, Washington, DC

University of Colorado, Denver, CO

The National Institutes of Health, Bethesda, MD.

Address correspondence and reprint requests to Joseph A. Sclafani, MD, 102 Irving Street NW, Washington, DC 20010. E-mail:

Received 14 December, 2015

Revised 18 May, 2016

Accepted 23 May, 2016

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

The Intramural Research Program of the National Institutes of Health funds were received in support of this work.

Relevant financial activities outside the submitted work: employment, patents, stocks, grants.

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