Longitudinal Analysis of the Care Pathway of Patients with Lumbar Spinal Stenosis in the US

Ramana K Naidu,1 Oth V Tran,2 Michael E Schatman3,4 1Pain Management, Marin Health Medical Center, Greenbrae, CA, USA; 2Health Economics & Outcomes Research, Boston Scientific, Marlborough, MA, USA; 3Department of Anesthesiology, Perioperative Care, and Pain Medicine, NYU Grossman School of Medicine, New York, NY, USA; 4Department of Population Health – Division of Medical Ethics, NYU Grossman School of Medicine, New York, NY, USACorrespondence: Oth V Tran, Email Oth.v.tran@gmail.comBackground: Evidence regarding the frequency and timing of treatment for lumbar spinal stenosis (LSS) fails to offer clear consensus. We describe the LSS care journey from initial diagnosis to first surgical intervention.Methods: Using Medicare claims database from 2009 through 2020, we identified patients who were diagnosed with LSS. The use and timing of conservative and surgical treatments during the entire follow-up from the initial diagnosis were reported.Results: Of the 143,849 patients identified, 68% received conservative care within 8.4 months and 25.3% received a surgical or minimally invasive intervention over 5.7 years following initial diagnosis, with 12.6% undergoing open decompression alone, 10.2% undergoing open decompression with fusion, and 5.1% undergoing fusion surgery alone. Fewer than 1% were provided with interspinous spacers or a percutaneous image-guided lumbar decompression.Conclusion: Approximately three-quarters of patients in the study received no surgical or non-invasive interventions for approximately six years following diagnosis with LSS.Keywords: lumbar spinal stenosis, interspinous spacer, lumbar decompression, chronic pain