Prevalence of interventional spine procedures performed by pain management physicians: blurred boundaries

Interventional pain management physicians (IPMPs) and spine surgeons are allies in treating spinal disorders. In addition to medical management, IPMPs can perform procedures such as epidural injections, rhizotomies, or kyphoplasties to bring relief to patients. However, some IPMPs perform procedures traditionally performed by spine surgeons, such as minimally invasive spine surgery, neural decompression, and spinal fusion. The line between spine procedures performed by spine surgeons and interventional pain management procedures performed by IPMPs has blurred. This study aimed to determine the incidence of IPMPs performing interventional spinal procedures traditionally performed by spine surgeons.

IPMPs were identified through the American Society of Interventional Pain Physicians (ASIPP) DoctorFinder database. Each physician's Scopus profile was evaluated to determine academic productivity. Personal physician websites were queried to determine whether they offered minimally invasive or open spinal procedures. Potential associations and differences among IPMPs performing interventional spinal procedures were analyzed using descriptive statistics, independent-sample t-tests, and chi-square analyses.

After neurosurgeons and orthopedic surgeons were removed from the initial list of 325 registered healthcare providers, 269 providers were included in the analysis (mean [SD] age, 56.3 [9.6] years). Physician degrees included MD (n = 237) and DO (n = 32). Some physicians held an additional degree (MS [n = 4], PhD [n = 4], and unspecified [n = 38]). Of the 269 healthcare providers, 130 had Scopus research profiles (mean publications, 24.2; mean h-index, 6.0; mean citations, 925.6). Seventy-four physicians (27.5%) performed interventional spinal procedures: 35 (13.0%) performed minimally invasive lumbar decompression (mild procedure), 33 (12.3%) performed Superion or Vertiflex interspinous spacer insertion, 18 (6.7%) performed spinal arthrodesis or fusion, 26 (9.7%) performed discectomies, 11 (4.1%) performed Minuteman interspinous-interlaminar fusion, 1 (0.4%) performed disc replacement, and 14 (5.2%) performed other unspecified decompressive spinal procedures. There were no significant differences in age (p = 0.62), publication number (p = 0.19), h-index (p = 0.53), citation count (p = 0.44), and fellowship incidence (p = 0.19) between IPMPs who performed interventional spine procedures and those who did not. No significant associations were found between sex (p = 0.19), medical degree (MD: p = 0.07, DO: p = 0.11), or number of publications (p = 0.38) and whether interventional spinal procedures were performed.

The incidence of invasive spine procedures performed by IPMPs is high. Future studies must analyze patient-reported outcomes, and differences in the training for traditional spine surgery interventions performed by surgeons and interventional pain spinal procedures performed by IPMPs must be better defined.