1
|
Abstract
OBJECTIVE In this narrative review, the current literature on therapeutic interventions for low back pain of facet joint etiology is assessed from an economic value perspective. SUMMARY OF BACKGROUND DATA The efficacy and economics of facet joint interventions in the treatment of lumbar back pain is a controversial topic. Trends show that facet joint interventions are becoming increasingly used, perhaps as physicians become more averse to treating chronic low back pain with opioids. With the emphasis on value-based spine care and changing reimbursement models, the perspective of rigorously evaluating the outcomes these interventions provide and the costs they incur is particularly relevant. DISCUSSION Although the evidence is noted to be limited, most systematic reviews fail to demonstrate the therapeutic utility of intra-articular facet joint injections in low back pain because of high study heterogeneity. A few good quality studies and systematic reviews describe moderate evidence for the utilization of therapeutic medial branch blocks and radiofrequency neurotomies in alleviating facet joint pain. CONCLUSION Consequently, there is a need for high-quality cost-effectiveness studies for facet joint interventions so that evidence-based and economically viable solutions can be used to optimize patient care at a societally affordable price.
Collapse
|
2
|
Passias PG, Horn SR, Segreto FA, Bortz CA, Pierce KE, Vasquez-Montes D, Moon J, Varlotta CG, Raman T, Frangella NJ, Stekas N, Lafage R, Lafage V, Gerling MC, Protopsaltis TS, Buckland AJ, Fischer CR. ODI Cannot Account for All Variation in PROMIS Scores in Patients With Thoracolumbar Disorders. Global Spine J 2020; 10:399-405. [PMID: 32435558 PMCID: PMC7222681 DOI: 10.1177/2192568219851478] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
STUDY DESIGN Retrospective review of single institution. OBJECTIVE To assess the relationship between Patient-Reported Outcomes Measurement Information System (PROMIS) and Oswestry Disability Index (ODI) scores in thoracolumbar patients. METHODS Included: Patients ≥18 years with a thoracolumbar spine condition (spinal stenosis, disc herniation, low back pain, disc degeneration, spondylolysis). Bivariate correlations assessed the linear relationships between ODI and PROMIS (Physical Function, Pain Intensity, and Pain Interference). Correlation cutoffs assessed patients with high and low correlation between ODI and PROMIS. Linear regression predicted the relationship of ODI to PROMIS. RESULTS A total of 206 patients (age 53.7 ± 16.6 years, 49.5% female) were included. ODI correlated with PROMIS Physical Function (r = -0.763, P < .001), Pain Interference (r = 0.800, P < .001), and Pain Intensity (r = 0.706, P < .001). ODI strongly predicted PROMIS for Physical Function (R 2 = 0.58, P < .001), Pain Intensity (R 2 = 0.50, P < .001), and Pain Interference (R 2 = 0.64, P < .001); however, there is variability in PROMIS that ODI cannot account for. ODI questions about sitting and sleeping were weakly correlated across the 3 PROMIS domains. Linear regression showed overall ODI score as accounting for 58.3% (R 2 = 0.583) of the variance in PROMIS Physical Function, 63.9% (R 2 = 0.639) of the variance in Pain Interference score, and 49.9% (R 2 = 0.499) of the variance in Pain Intensity score. CONCLUSIONS There is a large amount of variability with PROMIS that cannot be accounted for with ODI. ODI questions regarding walking, social life, and lifting ability correlate strongly with PROMIS while sitting, standing, and sleeping do not. These results reinforce the utility of PROMIS as a valid assessment for low back disability, while indicating the need for further evaluation of the factors responsible for variation between PROMIS and ODI.
Collapse
Affiliation(s)
- Peter G. Passias
- NYU Langone Orthopedic Hospital, Manhattan, NY, USA,Peter G. Passias, NYU School of Medicine, Division of Spinal Surgery, Department of Orthopaedic and Neurological Surgery, New York Spine Institute, 301 East 17th Street, New York, NY 10003, USA.
| | | | | | | | | | | | - John Moon
- NYU Langone Orthopedic Hospital, Manhattan, NY, USA
| | | | - Tina Raman
- NYU Langone Orthopedic Hospital, Manhattan, NY, USA
| | | | | | | | | | | | | | | | | |
Collapse
|
3
|
Hopkins B, Mazmudar A, Kesavabhotla K, Patel AA. Economic Value in Minimally Invasive Spine Surgery. Curr Rev Musculoskelet Med 2019; 12:300-304. [PMID: 31236835 PMCID: PMC6684673 DOI: 10.1007/s12178-019-09560-8] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
PURPOSE OF REVIEW The field of spine surgery remains a unique target in the transition to value-based care. While spine surgery has benefited from new medical technologies, including minimally invasive surgery (MIS), these technologies may be a key driver in rising US healthcare costs. As such, MIS needs to clear an economic value threshold through a rigorous evaluation of the outcomes they provide and costs they incur. In this article, we review recent MIS surgery literature from the perspective of economic value. RECENT FINDINGS Many studies report modest all-in cost savings and direct procedural cost equivalence for minimally invasive approaches relative to open surgeries. In terms of quality, studies found lower blood loss, length of stay, and infectious complications with MIS surgery but evidence on QALYs was mixed. In the past 5 years, there has been increasing research interest in defining economic value in MIS surgery. However, a significant amount of heterogeneity in research quality and methodology persists. Therefore, MIS surgery has the potential to be of high economic value, though this is not yet definitive. Future research should continue to focus on high-quality cost-effectiveness studies with clear methodologies to further elucidate economic value in MIS surgery.
Collapse
Affiliation(s)
- Benjamin Hopkins
- Department of Neurological Surgery, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Aditya Mazmudar
- Department of Orthopaedic Surgery, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA.
| | - Kartik Kesavabhotla
- Department of Neurological Surgery, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Alpesh A Patel
- Department of Orthopaedic Surgery, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| |
Collapse
|