Objectives: Emphasis on exhausting all conservative treatments before resorting to surgical intervention is becoming more ubiquitous, especially when seeking authorization for invasive procedures from health insurance payors. We analyzed the treatments and outcomes, along with perception of improvement for lumbar radiculopathy patients who presented to an interdisciplinary spine clinic, which emphases conservative care first.
Design: Chart audits were conducted on patients treated in 2018 for lumbar radiculopathy. Demographics, number of visits, prescribed therapies, if epidural steroid injection was recommended, how many injections were performed, referral to surgeon and if surgery was performed was aggregated and analyzed. Patients were then contacted via phone and email and asked what percent improvement they felt was gained from the prescribed therapies.
Results: 628 charts were audited, and attempts were made to contact via phone and email, with a 32% patient response rate (n=200). Injection therapy was recommended for 71.5% of patients, with the mean number of injections performed at 2.2±1.7, with an overall improvement rate of 53±38.5%. All age groups were prescribed other treatments, 48% receiving a combination of prescribed therapies. Global surgery rate was 15.1%, significantly below the national surgical intervention average of 33%. This below average surgical rate is associated with a cost avoidance upwards of $536,000 for the fiscal year. Overall, 65% of patients reported improvement from the treatments and therapies prescribed.
Conclusions: While there is no one therapy or intervention that overwhelmingly treats lumbar radiculopathy and its associated symptoms, a multifocal conservative approach including epidural steroid injections provides significant improvement. A conservative approach to spine care prevents unnecessary surgeries and promotes care pathways that provide quality care with fiscal responsibility.
Devender Singh– Research Scientist, Ascension Seton Spine and Scoliosis Center
Eeric Truumees– Orthopedic Surgeon, Ascension Seton Spine and Scoliosis Center
Lee Moroz– Physiatrist, Ascension Seton Spine and Scoliosis Center
Enrique Pena– Physiatrist, Ascension Seton Spine and Scoliosis Center
Ashley Duncan– Clinical Program Coordinator, Ascension Seton Spine and Scoliosis Center
David Truumees– Research Assistant, Ascension Seton Spine and Scoliosis Center
Eric Mayer– Physiatrist, Ascension Seton Spine and Scoliosis Center