Interventions of interest:

  • Automated percutaneous lumbar discectomy
  • Coblation nucleoplasty
  • Epidural steroid injections
  • Intradiscal electrothermal therapy
  • Interdisciplinary rehabilitation programs that combine physical therapy, exercise, workplace interventions, and cognitive retraining
  • Interspinous spacer systems
  • Laminectomy
  • Radiofrequency denervation
  • Spinal fusion
  • Surgical lumbar discectomy

Low back pain is an exceedingly common complaint, with a lifetime prevalence ranging
from 11-84% (Walker, 2000). Chronic low back pain may be seen in as many as 75% of
patients 6-12 months after an initial episode (Wahlgren, 1997). The economic impact of low
back pain is also substantial. It is the fifth most common reason for all physician visits in the
U.S. (Deyo, 2002; Hart, 1995), and is responsible for direct medical costs that approach $30
billion annually (Luo, 2003). In addition, low back pain is a major cause of lost productivity;
it is estimated that up to 2% of the U.S. work force is compensated for back pain or injury
each year (Taylor, 1985).

ICER’s appraisal concluded that the evidence on spinal injections and minimally-invasive procedures was either insufficient to be able to make a reasonable comparison with conservative treatment, or at best suggested that there was no additional clinical benefit over conservative treatment for most patients.

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Final Documents

Below you will find the final documents from the assessment review process:

“Clinicians have struggled for decades to effectively help patients with various types of low back disorders, all of which can severely affect patients’ quality of life, not to mention the impact on productivity at work and on associated medical care costs. Our report will help physicians, patients and policymakers understand what the latest evidence is on the relative effectiveness of interdisciplinary rehabilitation programs, injections, minimally-invasive procedures, and surgical approaches to managing this common problem.”