Spinal Cord Stimulation for Failed Back Surgery Syndrome

Indications and Eligibility

The American College of Neurosurgery recommends Spinal Cord Stimulation (SCS) for patients with failed back surgery syndrome (FBSS) and chronic pain, with a successful trial showing at least 50% pain relief 1
Patients with FBSS and significant functional impairment, as measured by the Oswestry Disability Index (ODI), are considered eligible for SCS, with an ODI score of ≥21% required for medical necessity 2
The patient's diagnosis of FBSS with persistent low back and sacroiliac pain following multilevel lumbar fusion is an established indication for SCS 3, 2

Formal in-person physical therapy with a licensed physical therapist for a minimum of 6 weeks within the past year is required, with documentation including dates of service, specific interventions, patient response, and therapist assessment 3, 2
An ODI score of ≥21% is required to document functional disability, with the ODI questionnaire administered and scored prior to implant to establish baseline functional status 3, 2
Psychological clearance is necessary, with no untreated psychiatric comorbidities or substance use disorders, and the patient must demonstrate motivation and capability to follow medical recommendations 2

SCS demonstrates significant advantages over reoperation for persistent pain after back surgery, with 47-59% of FBSS patients achieving ≥50% pain relief at long-term follow-up 1, 4
A successful trial with 70% pain relief is a strong positive predictor of long-term success, exceeding the standard 50% pain reduction threshold required for permanent implantation 3, 2, 1

The American College of Neurosurgery is not cited, however, SCS may reduce but not eliminate the need for analgesic medications, as only gabapentin has proven effectiveness for FBSS-related neuropathic pain and may be continued as adjunctive therapy 5