New York Medical Treatment Guidelines: Spinal Cord Stimulator Implants

What is a Spinal Cord Stimulator?

Jeremy Janis
Jeremy janis, Esq.

A spinal cord stimulator is a system that uses implanted electrical leads and a battery powered implanted pulse generator to stimulate the back. A spinal cord stimulator is implanted in a surgical procedure that is not pre-authorized under the Non-Acute Pain Guidelines. Providers who want to perform this procedure must therefore request pre-authorization from the carrier before performing the procedure.

When is a Spinal Cord Stimulator Appropriate?

A spinal cord stimulator is prescribed for treatment of select patients with chronic back or neck radicular pain, specifically patents with failed neck or back surgery that have:

    • Persistent severe and functionally disabling radicular pain.
    • Been provided with conservative non-surgical treatments.
    • Undergone surgical treatment that failed to relieve symptoms and improve function and further surgery has been considered but not approved this time
    • Complex regional pain syndrome, phantom limb and spinal cord injury dysethesias

Are there any pre-requisites to getting a spinal cord stimulator?

The medical provider must provide the treating physician’s detailed history, physical exam and complete diagnostic workup.  Further, all claimant must undergo a comprehensive psychological evaluation to ensure they are no significant behavioral factors that would predict poor response to a SCs.

The psychological evaluation must include a clinical interview and complete review of the records, a standardized detailed personality inventory and pain inventory.   The psychological evaluation should demonstrate there are no primary risk factors or red flags and that the patient has a demonstrated history or motivation and adherence to prescribed treatments.   Only if the claimant meets all pre-requisites may the claimant be eligible for pre-authorization for a spinal cord stimulator screening trial to determine how effective it might be.

The screening trial

During the trial, patient receives a temporary external device for three to seven days while completing normal daily activities.  Upon completion of the trial, the results are evaluated to determine if the patient is a candidate for a permanent spinal cord stimulator implant.   The patient is required to maintain a pain an activity diary during the screening trial.

A screening trial is considered successful if:

  • Stimulation covers the patient’s pain areas
  • Patient is comfortable with the feeling of stimulation.
  • Patient experiences a 50% decrease in pain, which must be validated by either the Visual Analog Scale or numerical rating scale.
  • Demonstrates objective functional gains or decreased use of pain meds

Only if the pre-screening is successful can the treating physician request pre-authorization from the carrier to implant a permanent spinal cord stimulator.

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Jeremy Janis is an associate attorney at Lois LLC where he defends employers and carriers in New York workers’ compensation claims. He regularly handles trials and hearings and has extensive experience deposing medical professionals and other experts and advising on all aspects of workers’ compensation law. He can be reached directly at jjanis@loisllc.com or 201-880-7213.