Sclafani Joseph A, Constantin Alexandra, Ho Pei-Shu, Akuthota Venu, Chan Leighton
Medstar Georgetown University/National Rehabilitation Hospital, Washington, DC.
The National Institutes of Health, Bethesda, MD.
Spine (Phila Pa 1976). 2017 Feb 15;42(4):240-246. doi: 10.1097/BRS.0000000000001724.
A retrospective, observational study.
The aim of this study was to determine the utilization of various treatment modalities in the management of degenerative spondylolisthesis within Medicare beneficiaries.
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.
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.
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.
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.
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一项回顾性观察研究。
本研究旨在确定医疗保险受益人群中退行性腰椎滑脱症治疗方式的使用情况。
退行性腰椎滑脱症是有症状的下腰痛中常被诊断出的一种病症。包括物理治疗和介入技术在内的多种治疗方案可用于治疗具有临床意义的退行性腰椎滑脱症。
本研究使用了2000年至2011年医疗保险承保理赔的5%全国样本。确定了一组患有新的国际疾病分类第九版（ICD - 9）退行性腰椎滑脱症诊断代码的受益人群。使用当前程序术语代码来确定每年各专科针对该队列人群所实施手术的数量。
共有95647人纳入分析。初次诊断时的平均年龄为72.8±9.8岁。在该研究队列中，腰椎滑脱症在女性（69%）中比男性更常见，在白种人（88%）中比其他种族人群更常见。超过50%的受益人至少接受过一次注射，约三分之一（37%）接受过物理治疗，五分之一（21%）接受过脊柱手术，三分之一（36%）未采用这些干预措施中的任何一种。超过一半的手术（124280/216088）发生在诊断后的2年内。与麻醉科、介入放射科、神经外科和骨科手术专科相比，物理医学与康复专科进行的局部干预（经椎间孔和小关节干预）与选择性较低（椎板间）手术的比例更高。在该队列中，大多数物理治疗致力于被动治疗方式和关节活动度练习，而非主动强化训练方式。
介入技术和物理治疗是有症状的退行性腰椎滑脱症常用的治疗方式。了解这些技术的使用情况对于确定相对临床疗效和优化未来医疗保健支出非常重要。
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