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New York Medical Treatment Guidelines: Spinal Cord Stimulator Implants

What is a Spinal Cord Stimulator?

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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