Recent Explosive Growth Seen in Number of Spinal Procedures

Spinal steroid injections, nerve blocks, sacroiliac joint injections, and heat treatments to kill nerve endings have reached explosive numbers according to this report. In a 12-month period of time almost one million of these interventionalprocedures were done on 200,000 patients.

The patient database used for this study only included privately insured patients. Medicare, worker’s compensation, motor vehicle insurance, and Veterans Administration were not included. About 12 to 14 million people from all 50 states were represented in this study. And that only represents about five per cent of the total U.S. population surveyed. So it’s likely that many, many more of these interventional spinal procedures are really being done.

But is that so bad? Perhaps these numbers reflect the fact that physicians have found a treatment that works for back pain. And once they sharpen their skills by doing more of these procedures, their results improve. Word spreads and more people seek their services. That is one possible scenario.

But the authors of this study think it’s more likely that a small number of physicians have found an easy way to make a profit. They suggest that overutilization of these procedures is contributing to the high cost of health care without corresponding high-quality evidence to support this treatment.

Here’s a closer look at what they uncovered. Only a few providers are responsible for a disproportionately high number of interventional spinal procedures. Neurologists and pain specialists are at the top of the list for the number of these spinal procedures that are done. In fact almost 40 per cent of all spinal pain procedures mentioned here are done by this small group of physicians.

What is the significance of these findings? The bottom-line in the economics of health care is preventing overutilization and cost containment. What recommendations would be appropriate in the face of this information? Here’s what the authors suggest:

  • Studies are needed to identify what really works for back pain. That treatment should be employed based on evidence-based guidelines.
  • Professional societies like the North American Spine Society need to provide specific guidelines for the use of interventional spinal procedures.
  • Universally accepted guidelines on the number of spinal interventions that should be done must be established. In this way, physicians and insurance companies would know what limits to follow.
  • Absolute cutoffs for the number of treatments that represent overutilization are needed.
  • Results of treatment should be tracked so that providers of high numbers of these procedures would have to show superior clinical results to justify this approach.

    In conclusion, this study shows that a small number of providers are responsible for a large number of interventional spinal procedures for back pain. This pattern of high utilization may represent overutilization and should be investigated further. Studies like this help shape health care policy by calling for accountability that includes reasonable and justifiable treatment guidelines.