Background: Multiple reviews have shown that interventional techniques for chronic pain have
increased dramatically over the years. Of these interventional techniques, both sacroiliac joint
injections and facet joint interventions showed explosive growth, followed by epidural procedures.
Percutaneous adhesiolysis procedures have not been assessed for their utilization patterns
separately from epidural injections.
Study Design: An analysis of the utilization patterns of percutaneous adhesiolysis procedures in
managing chronic low back pain in the Medicare population from 2000 to 2011.
Objective: To assess the utilization and growth patterns of percutaneous adhesiolysis in
managing chronic low back pain.
Methods: The study was performed utilizing the Centers for Medicare and Medicaid Services
(CMS) Physician Supplier Procedure Summary Master of Fee-For-Service (FFS) Data from 2000 to
2011.
Results: Percutaneous adhesiolysis procedures increased 47% with an annual growth rate of
3.6% in the FFS Medicare population from 2000 to 2011. These growth rates are significantly
lower than the growth rates for sacroiliac joint injections (331%), facet joint interventions (308%),
and epidural injections (130%), but substantially lower than lumbar transforaminal injections
(665%) and lumbar facet joint neurolysis (544%).
Limitations: Study limitations include lack of inclusion of Medicare Advantage patients. In
addition, the statewide data is based on claims which may include the contiguous or other states.
Conclusion: Percutaneous adhesiolysis utilization increased moderately in Medicare beneficiaries
from 2000 to 2011. Overall, there was an increase of 47% in the utilization of adhesiolysis
procedures per 100,000 Medicare beneficiaries, with an annual geometric average increase of
3.6%.
Key words: Interventional techniques, chronic spinal pain, epidural steroid injections,
percutaneous adhesiolysis, post surgery syndrome, spinal stenosis
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