Abstract
Introduction
Lumbar disc herniation is one of the major factors leading to lumbar radiculopathy. Both operative and nonoperative treatments have been shown to be effective in treating patients with lumbar herniated disc and radiculopathy. Even though both approaches can provide a rapid improvement, there are potential adverse events and rising costs associated with both, surgical and nonsurgical procedures. The aim of our study was to better understand the procedural trends, cost, and re-operative incidence in patients with lumbar herniated discs and radiculopathy.
Patients and Methods
Patients with lumbar herniated disc and radiculopathy from 2007 to 2010 were identified in the United healthcare database using ICD-9 and CPT codes. Treatment procedure were recorded and classified in the following three groups: surgical group, including discectomy, microdiscectomy, and endoscopic direct visualization discectomy procedures; minimally invasive group, including endoscopic assistance indirect visualization discectomy, intervertebral chemonucleolysis, and disc aspiration; and nonsurgical group, including bed rest, analgesics, nonsteroidal anti-inflammatory drugs, exercise, physical therapy, or epidural steroid injection. Data were collected and analyzed based on the patient age (< 40, 40–65, and > 65 years) and regional distribution (Midwest, Northeast, South, and West).
Results
A total of 162,682 patients were diagnosed with lumbar disc herniation with sciatica. There were 10,183 patients within the surgical group, 235 in the minimally invasive group, and 152,337 patients in nonsurgical group. There was a significant difference in procedure type based on the age and region. In < 40 years of age subgroup, there was an increase in the operation rates, 5.99, 6.15, 6.32, and 6.51%, from 2007 through 2010. The operation rates decreased with age, 6.95% (< 40 years), 5.65% (40–65 years), and 4.28% in > 65 years group. On the other hand, number of nonsurgical procedures increased with age and was 92.57, 93.99, and 95.32%, respectively. Surgical rates were the highest in the West region (7.58%) and the lowest in the Northeast (3.67%). Nonsurgical procedures had the opposite trends with the Northeast (96.18%) having the highest and West (92.31%) the lowest rate.
Conclusion
There was a difference in the operation rate based on the age and region distribution, with the subgroup < 40 years having the highest operation rate and the > 65 years of age subgroup having the lowest operation rate. The West region has the highest and the Northeast region has the lowest operational rate. Within the nonsurgical group, we observed opposite trends. Our next steps include cost analyzes and defining the surgical likelihood of patient having nonoperative procedures.