Spinal Cord Stimulation for Diabetic Neuropathy

Medical Necessity Assessment

The American Academy of Physical Medicine and Rehabilitation recommends spinal cord stimulation for patients with chronic diabetic polyneuropathy and moderate to severe pain, who have failed conventional medical management, as seen in this patient with a documented history of chronic diabetic polyneuropathy and moderate to severe pain (6/10) for over 12 months 1, 3
The American Diabetes Association suggests that patients with diabetic neuropathy should have failed conventional medical management, including medications such as pregabalin and oxycodone, and physical therapy for at least 6 months, which is consistent with this patient's history 1, 3
The patient's functional disability, with an ODI score of 50%, exceeds the required 21%, indicating significant functional impairment, according to the American Academy of Physical Medicine and Rehabilitation 1

The American Academy of Neurology recognizes spinal cord stimulation as an established treatment for peripheral neuropathic pain, including diabetic neuropathy, that has failed to respond to conventional therapies, with a strength of evidence classified as Level A, according to the American Academy of Neurology 5, 4

The patient's previous experience with spinal cord stimulation, which resulted in 80% improvement, suggests that they may be a good candidate for reimplantation, according to the American Academy of Physical Medicine and Rehabilitation 4
The patient's improved diabetic control, with an A1C of 7.3, may impact neuropathic symptoms, and continued glycemic control monitoring is recommended, according to the American Diabetes Association 3, 4

The American Academy of Physical Medicine and Rehabilitation recommends that an infectious disease specialist consultation is mandatory before proceeding with permanent implantation to confirm the previous infection has been completely eradicated, with a strength of evidence classified as Level A 1
The Centers for Disease Control and Prevention suggest that MRSA testing should be part of pre-operative preparation, which has been appropriately planned for this patient 1