Alexander Bailey, MD, a spine surgeon at Precision Spine & Orthopaedic Specialists in Overland Park, Kan., discusses how spinal cord stimulation impacts back pain care and where the technology is headed in the future. Q: Why should spine surgeons and specialists consider incorporating spinal cord stimulation into their practice?Dr. Alexander Bailey: When we choose modalities to treat patients, many of them have a long history of pain and varying degrees of chronic pain. In spine surgery we tailor the treatment modalities to the problem. That can include physical therapy, medication, injections or surgery. I think that the complexity of the spine yields a variety of different options and growing trends nationwide consider spinal cord stimulation one of those modalities. I think patients are benefiting from those technologies even more than fusion surgery.
A variety of different groups are considering and growing their use of spinal cord stimulation from interventional pain physicians, spinal surgeons and anesthesiologists. We have to look for the best modality to treat patients. Sometimes even patients who have had multiple operations, scoliosis or complex pain, benefit more from a smaller operation and experience more pain relief.
Q: How is spinal cord stimulation use evolving?
AB: The growth in usage of this technology comes from a variety of different reasons, including technology has improved, surgical technique has improved and there is more awareness about it among physicians and patients. This is an alternative treatment to complex situations. The combination of all these things has led to growth of its use.
This is one technique and procedure, and it’s still evolving. Now, I'm able to use a trial implant through a percutaneous technique, so the surgery can be done in a hospital or outpatient surgery center. The procedures are all outpatient and patients typically go home the same day or the next day after a surgical lead implant.
One of the benefits of this procedure is having an insight on the outcome of my patients. This is the only technique that I get to try before the final implant, which is a benefit for me as well as the patient.
Q: Are there any other benefits you've noticed to spinal cord stimulation over other treatment options?
AB: I've been doing spinal cord stimulations for more than 10 years, and I've been well versed in the procedure and its ability to help patients. There has been development over the past decade that will make usage grow. We are now able to isolate and stimulate the appropriate areas of the spinal cord that optimizes pain relief. Those technologies have advanced and patients have benefited from these improvements.
The ability to capture back pain and precisely target the patient's areas of discomfort means better patient satisfaction on the ultimate outcome.
Q: Where is this technology headed in the future?
AB: I think a lot of different technologies using electrical engineering will emerge. The patient, who is the ultimate user, should have the ability to interface with this technology, which will lead to continual improvement. It's like the computer server; 50 years ago it was the size of a small house and now it's the size of an iPhone. With the availability of the electrical engineering components, there are a variety of engineering aspects that could be improved as well as programmability to precisely target patients' pain.
We have three companies that are actively involved in stimulation and they are working diligently in their various systems to improve. The paradigm shift in my practice has been the ability to capture back pain, which is parallel to my growth and usage of spinal cord stimulation. Ten to 15 years ago, spinal cord stimulation was primarily used for neuropathic pain affecting the legs, ignoring the back pain.
Now we can target and treat the back pain as well. This technology has led to the expectation in my practice to capture back pain in 85 percent of patients.
Q: Are you having any difficulty receiving reimbursement or coverage for spinal cord stimulators?
AB: Typically when it comes to coding a procedure and documenting the diagnosis, the conservative management techniques that have been rendered and the failure of those techniques leads to a surgically invasive procedure. They can be turned down because of lack of documentation or the need of new documentation. There are reasons that are diagnosable and codeable. If done appropriately for the treatment of patients, these techniques are highly warranted, on-label and indicated, so they are appropriately reimbursed.
Q: What impact could spinal cord stimulation have on the future?
AB: The number of people in chronic pain in this country is amazing. One in three pain patients have had pain for more than six months. That pain comes from a variety of different sources, and the economic impact has been estimated at $300 billion to $500 billion per year. If we talk about loss of work, workers compensation, loss of productivity and failed surgical procedures, it's a tremendous economic impact. We intervene case by case and help patients when we can with various procedures.
Spinal cord stimulation is incredibly satisfying to patients and physicians, and society as a whole. It is also a procedure that can be done as an outpatient procedure and doesn't involve much recovery time. That is very attractive to patients.
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