The North American Spine Society has revised its coverage recommendations for spinal cord stimulation.
The recommendations provide evidence-based guidance supporting coverage of spinal cord stimulation as a treatment for chronically painful spine conditions in patients who do not have surgical options, according to an Aug. 18 news release.
The revisions reflect the evolution of spinal cord stimulation literature, Byron Schneider, MD, co-chair of NASS’ coverage committee, said in the release.
Here are six things to know:
- The recommendations are meant to guide payer policy, not clinical practice. NASS said it is defining coverage positions for payers and members rather than waiting to comment on individual policies, in hopes of reducing disputes over coverage.
- The guidance reflects evidence available through February 2025. Any data or research published after Feb. 20, 2025, is not reflected in the recommendations and “could warrant deviations from this recommendation, if appropriate,” according to the document.
- A trial is indicated only when patients meet five criteria. The criteria are: moderate-to-severe axial spine or extremity pain from a spinal or neuropathic source; pain lasting a clinically appropriate duration, typically at least six months, that has persisted despite conservative treatment or prior surgery; no active substance abuse; a psychological evaluation ruling out significant cognitive dysfunction, active psychosis or poorly controlled psychological disorders; and either no identifiable structural cause treatable by surgery, or a patient who is not a surgical candidate.
- Repeat trials can be reasonable under specific circumstances. NASS said a second trial may be appropriate if the first failed due to technical issues such as electrode migration, if the patient’s condition or pain pattern changed substantially, if a new pain syndrome emerges that was not targeted initially, or if new SCS technology becomes available.
- Implantation requires a successful trial of at least 72 hours with a 50% pain reduction. Beyond pain relief, the recommendations require the patient to show significant improvement in functional status before moving to permanent implantation.
- Six scenarios rule out implantation. NASS lists untreated drug addiction, poorly controlled psychiatric disorders or social dysfunction, active systemic infection, pregnancy or lactation, inability to operate the device due to cognitive dysfunction, and general medical contraindication as reasons implantation is not indicated.
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