Pain Management Centers of America, Paducah, KY and Evansville, IN; LSU Health Science Center, New Orleans, LA.
Pain Management Centers of America, Evansville, IN.
Pain Physician. 2020 Mar;23(2):E133-E149.
Interventional techniques for managing spinal pain, from conservative modalities to surgical interventions, are thought to have been growing rapidly. Interventional techniques take center stage in managing chronic spinal pain. Specifically, facet joint interventions experienced explosive growth rates from 2000 to 2009, with a reversal of these growth patterns and in some settings, a trend of decline after 2009.
The objectives of this assessment of utilization patterns include providing an update of facet joint interventions in managing chronic spinal pain in the fee-for-service (FFS) Medicare population of the United States from 2000 to 2018.
The study was designed to assess utilization patterns and variables of facet joint interventions in managing chronic spinal pain from 2000 to 2018 in the FFS Medicare population in the United States.
Data for the analysis were obtained from the master database from the Centers for Medicare & Medicaid Services (CMS) physician/supplier procedure summary from 2000 to 2018.
Facet joint interventions increased 1.9% annually and 18.8% total from 2009 to 2018 per 100,000 FFS Medicare population compared with an annual increase of 17% and overall increase of 309.9% from 2000 to 2009. Lumbosacral facet joint nerve block sessions or visits decreased at an annual rate of 0.2% from 2009 to 2018, with an increase of 15.2% from 2000 to 2009. In contrast, lumbosacral facet joint neurolysis sessions increased at an annual rate of 7.4% from 2009 to 2018, and the utilization rate also increased at an annual rate of 23.0% from 2000 to 2009. The proportion of lumbar facet joint blocks sessions to lumbosacral facet joint neurolysis sessions changed from 6.7 in 2000 to 1.9 in 2018. Cervical and thoracic facet joint injections increased at an annual rate of 0.5% compared with cervicothoracic facet neurolysis sessions of 8.7% from 2009 to 2018. Cervical facet joint injections increased to 4.9% from 2009 to 2018 compared with neurolysis procedures of 112%. The proportion of cervical facet joint injection sessions to neurolysis sessions changed from 8.9 in 2000 to 2.4 in 2018.
This analysis is limited by inclusion of only the FFS Medicare population, without adding utilization patterns of Medicare Advantage plans, which constitutes almost 30% of the Medicare population. The utilization data for individual states also continues to be sparse and may not be accurate.
Utilization patterns of facet joint interventions increased 1.9% per 100,000 Medicare population from 2009 to 2018. This results from an annual decline of - 0.2% lumbar facet joint injection sessions but with an increase of facet joint radiofrequency sessions of 7.4%.
Interventional techniques, facet joint interventions, facet joint nerve blocks, facet joint neurolysis.
从保守疗法到手术干预，治疗脊柱疼痛的介入技术被认为发展迅速。介入技术在治疗慢性脊柱疼痛中占据中心地位。具体来说，关节突关节介入在 2000 年至 2009 年期间经历了爆炸式增长，此后这些增长模式发生逆转，在某些情况下，2009 年后呈下降趋势。
本评估利用模式的目的包括提供美国医疗保险按服务付费（FFS）人群中 2000 年至 2018 年治疗慢性脊柱疼痛的关节突关节介入利用情况的最新信息。
该研究旨在评估 2000 年至 2018 年美国 FFS 医疗保险人群中治疗慢性脊柱疼痛的关节突关节介入利用模式和变量。
分析数据来自 2000 年至 2018 年 CMS 医生/供应商程序汇总的医疗保险主数据库。
与 2000 年至 2009 年相比，2009 年至 2018 年，每 10 万 FFS 医疗保险人群中关节突关节介入每年增加 1.9%，总增加 18.8%，而每年增加 17%，总增加 309.9%。与 2009 年至 2018 年每年减少 0.2%相比，2009 年至 2018 年腰椎骶髂关节神经阻滞次数或就诊次数每年减少 0.2%，而 2000 年至 2009 年每年增加 15.2%。相比之下，2009 年至 2018 年腰椎骶髂关节神经松解术的利用率每年增加 7.4%，利用率也每年增加 23.0%，从 2000 年至 2009 年。腰椎关节突关节阻滞与腰椎骶髂关节神经松解术的比例从 2000 年的 6.7 变为 2018 年的 1.9。与 2009 年至 2018 年的颈胸关节突关节神经松解术相比，颈椎和胸椎关节突关节注射每年增加 0.5%。与 2009 年至 2018 年的神经松解术相比，颈椎关节突关节注射从 2009 年至 2018 年增加到 4.9%。从 2000 年的 8.9%变为 2018 年的 2.4%。
本分析仅限于 FFS 医疗保险人群，不包括医疗保险优势计划的利用模式，医疗保险优势计划约占医疗保险人群的 30%。各州的利用数据也仍然很少，可能不准确。
从 2009 年至 2018 年，每 10 万 Medicare 人群中关节突关节介入的利用率增加了 1.9%。这是由于腰椎关节突关节注射次数每年减少 0.2%，但关节突关节射频次数增加了 7.4%。
介入技术，关节突关节介入，关节突关节神经阻滞，关节突关节神经松解术。
