To Operate or Not: A Nationwide Analysis of Factors Influencing the Likelihood of Surgical Treatment in Patients Presenting with Lumbar or Lumbosacral Disc Disorders and Radiculopathy

Introduction: Disc disorders presenting with radiculopathy can be treated with multiple interventions. The Spine Patient Outcomes Research Trial was a landmark study that found no significant advantage to surgical treatment for lumbar disc herniation at two-year follow-up, with a modest advantage for surgical patients at eight-year follow-up. To add context to these results, this study aimed to define the epidemiology of lumbar and lumbosacral disc disorders presenting to the ED with radiculopathy and to quantify unexplored social determinants of health influencing whether a patient is taken to surgery.

Methods: Data from the 2016-2019 Nationwide Emergency Department Samples was queried. Patient encounters presenting to the ED with a principal diagnosis of lumbar or lumbosacral disc disorders and radiculopathy were queried by the ICD10 codes “M51.16” and “M51.17”. Multivariate logistic regression was performed to quantify the factors influencing the likelihood that a patient underwent spine surgery following presentation to the ED.

Results: 48,141 patients were included. 8,648 (18.0%) patients underwent spine surgery following presentation to the ED. Patients that were males (OR = 1.20, CI = 1.14-1.27, p < 0.001), of younger age (OR = 0.98, CI = 0.98-0.98, p < 0.001), insured privately (OR = 1.65, CI = 1.53-1.79, p < 0.001), and with more co-morbid ICD 10 diagnoses on presentation to the ED (OR = 1.11, CI = 1.11-1.12, p < 0.001) were more likely to undergo surgery. Admission to not-for-profit (OR = 0.75, CI = 0.71-0.80, p< 0.001) or government-owned (OR = 0.71, CI = 0.63-0.79, p < 0.001) hospitals was associated with a decreased likelihood of surgical treatment.

Conclusion : This study highlights the epidemiology of patients presenting to the ED with disc disorders and radiculopathy. It identifies the patient and hospital-system factors that influence whether surgical treatment occurs. Further work is necessary to help provide more equitable care.