Bhandutia Amit, Yang Min, Liu Qing, Gao Yipeng, Liu Jiaxuan, Liu Steven, Guo Amy, Chauhan Kinsuk
Department of Orthopaedics, Louisiana State University Health Sciences Center, New Orleans, LA, United States.
Healthcare, Analysis Group, Inc., Boston, MA, United States.
N Am Spine Soc J. 2025 Jun 21;23:100757. doi: 10.1016/j.xnsj.2025.100757. eCollection 2025 Sep.
Lumbar disc herniation (LDH) affects approximately 1% to 3% of the population annually and leads to substantial physical burden, quality-of-life burden, and productivity loss. Commonly used interventions, including pharmacological and epidural steroid injections (ESIs), have limited high-quality evidence to support their effectiveness in the long-term for treating LDH beyond symptom relief. In general, there is a lack of consensus for timing of treatment after LDH onset and limited data on real-world treatment of LDH. The objective of this study was to describe current real-world treatment patterns and inform gaps in clinical management of patients with LDH.
A retrospective analysis was performed using data from January 01, 2018 through March 31, 2023 of a United States commercial health insurance claims database (IQVIA PharMetrics Plus). Patients aged 30-70 years with newly-diagnosed LDH and continuous insurance enrollment for ≥6 months before and ≥12 months after index (first) LDH diagnosis were included. Relevant billing codes were used to identify LDH, related treatments (nonpharmacologic, pharmacologic, invasive), and comorbidities. Demographic and clinical characteristics were summarized for the baseline (preindex) period. Treatment patterns were described over the follow-up period, up to 3 years after LDH diagnosis. Time from LDH diagnosis to ESI(s) and surgery(ies) were calculated.
A total of 1,086,552 patients with LDH were included, with a mean age of 50.8 years. Patients had a mean follow-up of 27 months after LDH diagnosis. Nearly 20% of patients with LDH underwent ESI, with half of this group undergoing multiple ESIs. Multiple ESIs were associated with a greater likelihood of surgical intervention and repeat surgical intervention compared to those who only underwent single ESI. LDH surgery was performed on 7.2% of patients, approximately 10% of whom had multiple surgeries during follow-up. A large subset (44.1%) of patients who underwent LDH surgery did not have any ESI prior to surgery. General limitations of claims data analyses can include data misclassification, missing claims for diagnoses and procedures that were conducted, missing clinical information (severity of condition, insights into clinical decision making), and some missing patient demographics and characteristics.
In this study, approximately one quarter of patients with LDH underwent ESI and/or surgery after conservative treatment. Opportunities exist to provide more guideline-concordant care to patients with LDH. In addition, unmet needs exist in the current treatment options for patients with LDH, potentially including the need for other nonsurgical treatment options for patients who do not fully respond to conservative treatment.
腰椎间盘突出症（LDH）每年影响约1%至3%的人群，会导致严重的身体负担、生活质量负担和生产力损失。常用的干预措施，包括药物治疗和硬膜外类固醇注射（ESI），缺乏高质量证据来支持其在长期治疗LDH方面除缓解症状外的有效性。一般来说，对于LDH发病后治疗时机缺乏共识，且关于LDH实际治疗的数据有限。本研究的目的是描述当前的实际治疗模式，并指出LDH患者临床管理中的差距。
使用美国商业健康保险理赔数据库（IQVIA PharMetrics Plus）2018年1月1日至2023年3月31日的数据进行回顾性分析。纳入年龄在30 - 70岁之间、新诊断为LDH且在索引（首次）LDH诊断前连续参保≥6个月且诊断后连续参保≥12个月的患者。使用相关计费代码来识别LDH、相关治疗（非药物、药物、侵入性）和合并症。总结基线（索引前）期的人口统计学和临床特征。描述随访期（直至LDH诊断后3年）的治疗模式。计算从LDH诊断到进行ESI和手术的时间。
共纳入1,086,552例LDH患者，平均年龄为50.8岁。患者在LDH诊断后的平均随访时间为27个月。近20%的LDH患者接受了ESI，其中一半接受了多次ESI。与仅接受单次ESI的患者相比，多次ESI与手术干预和再次手术干预的可能性更大有关。7.2%的患者接受了LDH手术，其中约10%在随访期间进行了多次手术。接受LDH手术的患者中有很大一部分（44.1%）在手术前未进行任何ESI。理赔数据分析的一般局限性可能包括数据错误分类、已进行的诊断和手术的理赔缺失、临床信息缺失（病情严重程度、临床决策洞察）以及一些患者人口统计学和特征缺失。
在本研究中，约四分之一的LDH患者在保守治疗后接受了ESI和/或手术。有机会为LDH患者提供更符合指南的护理。此外，LDH患者当前的治疗选择存在未满足的需求，可能包括对于对保守治疗不完全反应的患者需要其他非手术治疗选择。
