Clinical Survey: Patterns of Utilization of Lumbar Epidural Steroid Injections by a Cohort of Spinal Surgeons

Lebude, Bryan; Wang, Dajie; Harrop, James S.; Maltenfort, Mitchel; Anderson, D. Greg; Vaccaro, Alexander R.; Ratliff, John K.

doi:10.1016/j.pmrj.2008.11.013

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Volume 1, Issue 4 , Pages 329-334, April 2009

Clinical Survey: Patterns of Utilization of Lumbar Epidural Steroid Injections by a Cohort of Spinal Surgeons

Bryan Lebude, BA
- Jefferson Medical College, Thomas Jefferson University, Philadelphia, PA^†
Dajie Wang, MD
- Department of Anesthesiology, Thomas Jefferson University, Philadelphia, PA^‡
James S. Harrop, MD
- Department of Neurosurgery, Thomas Jefferson University, Philadelphia, PA 19107^§
Mitchel Maltenfort, PhD
- Department of Neurosurgery, Thomas Jefferson University, Philadelphia, PA^⁎⁎
D. Greg Anderson, MD
- Department of Orthopedic Surgery, Thomas Jefferson University, Philadelphia, PA^¶
Alexander R. Vaccaro, MD, PhD
- Department of Orthopedic Surgery, Thomas Jefferson University, Philadelphia, PA^∥
John K. Ratliff, MD
- Department of Neurosurgery, Thomas Jefferson University, 909 Walnut 2nd Floor, Philadelphia, PA 19107^#
- Address correspondence to: J.K.R.

Received 11 July 2008; accepted 21 November 2008.

Objective

There are few data on responses to conservative therapy in the management of lumbar degenerative diseases. To understand the use of epidural steroid injections (ESIs) by spine surgeons in the treatment of 2 distinct lumbar spinal conditions—herniated nucleus pulposus (HNP) and degenerative disk disease (DDD)—a survey of orthopedic and neurosurgical spine surgeons was conducted.

Design

Participants were surveyed via posting of a survey on a commercially maintained Web site. Respondents were queried on individual preferences regarding epidural steroid injections for HNP and DDD.

Setting

N/A.

Participants

The survey was completed by 61 surgeons; not all surgeons completed the entire survey. There was equal representation between orthopedic and neurosurgical spine surgeons; most surgeons reported being in practice for greater than 10 years (41%) and most surgeons reported completing between either 50 and 100 or 100 and 200 spine surgeries each year (26% and 31%).

Main Outcome Measures

Results were tabulated and assessed for variance. Both individual responses to the different ESI treatment protocols offered and difference in use of lumbar epidural steroids between diagnoses were analyzed.

Results

In treatment of lumbar HNP, the majority of respondents considered ESIs after 6 weeks of noninterventional care (69%). In lumbar DDD, there was no consensus as to overall use, timing, number of ESIs constituting a treatment regimen, number of treatment cycles recommended, and length of treatment before considering other intervention. In comparing treatment of lumbar HNP or DDD, there was no agreement with regard to timing of ESIs, with regard to duration of treatment, nor with regard to number of injections comprising a treatment regimen (κ = -0.01, 0.03, and -0.02, respectively).

Conclusion

No consensus was found as to timing, frequency, and duration of ESI treatment in lumbar HNP and DDD patients in a survey of practicing spine surgeons. These results illustrate one example of lack of consensus in conservative treatment protocols.