Counting the costs: case management implications of spinal cord stimulation treatment for failed back surgery syndrome.

PURPOSE/OBJECTIVES: The purpose of this article is to review clinical and health economic evidence supporting the use of spinal cord stimulation (SCS) for failed back surgery syndrome (FBSS) and to discuss implications for case managers' decision making.

PRIMARY PRACTICE SETTINGS: Primary settings include hospital and home environments.

FINDINGS/CONCLUSIONS: Patients with FBSS experience persistent or recurring pain in the lower back, legs, or both after one or more spinal surgeries. Surgical revision and nonsurgical FBSS therapies often result in minimal or no clinical improvement, and reoperations often result in more pain. The efficacy and safety of SCS have improved as a result of earlier intervention, technological advances, and increased awareness of SCS proper patient selection. A recent randomized controlled trial (RCT) demonstrated that at mean 3-year follow-up, SCS achieves significantly more pain relief and treatment satisfaction and lower opiate analgesic use than reoperation in patients with FBSS. Another RCT demonstrated that at 6-month follow-up, more patients with FBSS achieve pain relief, enhanced quality of life, improved functioning, and higher treatment satisfaction levels with SCS than with conventional medical management (CMM). Health-economic FBSS studies show that SCS is more cost-effective than CMM or reoperation. SCS is a well-established FBSS treatment option with demonstrated efficacy and cost-effectiveness in selected patients.

IMPLICATIONS FOR CM PRACTICE: Case Managers should consider recommending SCS as one modality prior to reoperation in patients with FBSS who meet the clinical criteria for its appropriate use.