Descriptive epidemiology was used for this analysis. This study aimed to examine patterns in lumbosacral transforaminal and interlaminar/caudal epidural injections across time, as well as patient characteristics associated with these procedures. Different lumbar diseases warrant different epidural injection locations, including transforaminal space and interlaminar/caudal space. Utilization patterns may change over time depending on factors like published research, physician preferences, insurance approval, and more. Current Procedural Terminology codes were used to search the M91Ortho PearlDiver database for patients who had undergone lumbosacral transforaminal and interlaminar/caudal epidural injections between 2010 and 2019. 

Prevalence per 100,000 insured lives was calculated by collecting data on patient age, gender, Elixhauser Comorbidity Index (ECI), insurance type (commercial, Medicaid, Medicare), and geographic location (Midwest, Northeast, South, West). Specifically, 426,039 patients and 501,228 patients were found to have received lumbosacral transforaminal or interlaminar/caudal epidural injections. During the time period under review, the annual rate of injections declined from 160.81 to 76.36 per 100,000 patients for transforaminal injections and from 200.53 to 77.56 for interlaminar/caudal injections. Those with Commercial and Medicare coverage saw the largest decreases in overall injections (53.40 and 66.50%, respectively), while those with Medicaid coverage saw the smallest decline (32.39%). 

The average age of injection patients has increased over time (P<0.05), and there has been a trend toward transforaminal injections. The majority of the injections were given by doctors who specialize in Anesthesiology (who gave fewer transforaminal injections than interlaminar/caudal ones). Epidural injections in the lumbosacral region (including transforaminal and interlaminar/caudal) decreased by 52.37% per 100,000 patients between 2010 and 2019. When painting a picture of overall spine treatment consumption, it is vital to account for the shifting demographics of persons receiving such injections and practice patterns. Disparities in care may exist as a result of the observed variations in injection utilization trends by patient insurance.

Source: journals.lww.com/spinejournal/Abstract/2022/12010/Changes_in_the_Utilization_of_Lumbosacral_Epidural.8.aspx