Utilization Patterns of Facet Joint Interventions in Managing Spinal Pain: a Retrospective Cohort Study in the US Fee-for-Service Medicare Population

• Published in: Current pain and headache reports 2019-10, Vol.23 (10), p.73-12, Article 73
• Main Authors: Manchikanti, Laxmaiah, Soin, Amol, Mann, Dharam P., Bakshi, Sanjay, Pampati, Vidyasagar, Kaye, Alan D., Hirsch, Joshua A.
• Format: Article
• Language: English
• Subjects: Back Pain - surgery; Chronic Pain - epidemiology; Chronic Pain - surgery; Cohort analysis; Expenditures; Headaches; Health care policy; Hot Topics in Pain and Headache (N Rosen; Humans; Internal Medicine; Medicaid; Medicare; Medicare - economics; Medicine; Medicine & Public Health; Narcotics; Neck pain; Neurosurgical Procedures; Pain Management - methods; Pain Medicine; Population; Section Editor; Topical Collection on Hot Topics in Pain and Headache; United States; Zygapophyseal Joint - surgery
• ISSN: 1531-3433; 1534-3081
• DOI: 10.1007/s11916-019-0816-7

Purpose of Review To assess patterns of utilization and variables of facet joint interventions in managing chronic spinal pain in a fee-for-service (FFS) Medicare population from 2009 to 2016, with a comparative analysis from 2000 to 2009 and 2009 to 2016. Recent Findings From 2009 to 2016, facet joint interventions increased at an annual rate of 2% per 100,000 Medicare population compared to 10.2% annual rate of increase from 2000 to 2009. Lumbosacral facet joint nerve block episodes decreased at an annual rate of 0.1% from 2009 to 2016, with an increase of 16.2% from 2000 to 2009. In contrast, lumbosacral facet joint neurolysis episodes increased at an annual rate of 7.6% from 2009 to 2016 and the utilization rate also increased at an annual rate of 26% from 2000 to 2009. The ratio of lumbar facet joint block episodes to lumbosacral facet joint neurolysis episodes changed from 6.7 in 2000 to 2.2 in 2016. From 2009 to 2016, cervical and thoracic facet joint injections increased at an annual rate of 0.6% compared to cervicothoracic facet neurolysis episodes of 9.2%. During 2000 to 2009, annual increase of cervical facet joint injections was 18% compared to neurolysis procedures of 26%. The ratio of cervical facet joint injections episodes to neurolysis episodes changed from 8.85 in 2000 to 2.8 in 2016. Summary In summary, based on available data, utilization patterns of facet joint interventions demonstrated an increase of 2% per 100,000 Medicare population from 2009 to 2016, with an annual decline of lumbar facet joint injection episodes.