Medical Student Duke University School of Medicine
Disclosure(s):
Tara Elizabeth Dalton, MD: No financial relationships to disclose
Introduction: Low back pain from lumbar degenerative disc disease (DDD) is a common cause of disability in the United States. Nonoperative management is typically preferred to address symptoms, but surgeries such as lumbar disc arthroplasty (LDA) may improve mobility and reduce adjacent segment disease in refractory cases. In 2019, there was a significant change in commercial insurance coverage of LDA, but it remains unclear the extent to which this impacted insurance coverage and utilization of LDA. In this study, we examined trends in LDA utilization in the United States, as well as associations between LDA and clinical outcomes.
Methods: A retrospective review was performed using the PearlDiver Patient Record Database to identify cases of lumbar DDD (ICD-9 and ICD-10 codes) undergoing LDA (CPT codes) from 2011 to 2021. Yearly LDA incidence estimates were compared, and trends were analyzed using regression models.
Results: A total of 13,618,621 patients with lumbar DDD were identified, with 1,645 LDA procedures recorded between 2011 and 2022. LDA incidence decreased from 2011 to 2015 (47%) but has steadily increased annually from 2016 to 2022. The largest increase was seen between 2019 and 2020 (54%). Overall, the incidence of LDA in the U.S. has increased by 34% during the time period examined.
Conclusion : This study provides valuable insights into the incidence of LDA between 2011 and 2022 and characterizes utilization rates by different factors. The decline in LDA utilization between 2011 and 2016 may be attributed to clinical outcomes, limited indications, or insurance restrictions. Despite the initial decline until 2016, the overall 34% increase in LDA utilization suggests growing popularity of this procedure, potentially related to changes in insurance coverage deeming lumbar disc implants medically necessary after meeting certain criteria.
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