Best Practices in Spinal Cord Stimulation

Study Design. A review of clinical best practices for spinal cord stimulation (SCS). Objective. The aim of this study is to summarize published and evidence based guidelines with regards to utilizing SCS, including patient selection, disease indication, perioperative management, complication mitigation strategies, and device selection. Additional focus has been provided on quality care to individual patients by acknowledging the importance of durable outcomes and care delivery costs. Summary of Background Data. For more than 30 years, SCS has successfully alleviated patient suffering and enhanced the lives of patients with refractory pain conditions. Prospective studies of SCS have consistently demonstrated benefits through reduction of pain, improvement in function, and reduced healthcare expenditures in select patient diagnosis groups. Although the benefits of SCS are well-supported, the clinical application of this therapy varies widely based on physician training and experience, regional clinical practice variations, and insurance coverage. Methods. This article provides a summary of published studies, case reports, evidence-based guidelines and expert consensus, with the intent of increasing physician competency and enhancing patient care through improved clinical outcomes. Results. A guide to SCS implantation, appropriate patient selection, ranked recommendations for diseases that may most benefit for SCS treatment, complication mitigation strategies, and finally, indications for choosing the most efficacious modality of SCS therapy for specific patients and pain conditions. Conclusion. Although SCS has been shown to be safe and effective for a number of pain conditions, emerging SCS modalities promise even greater efficacy over traditional SCS. To achieve this promise, physicians must carefully select and manage their patients and the SCS device. Level of Evidence: N\A

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