Permanent Implantation of Dorsal Column Stimulator for CRPS and Chronic Pain Syndrome

Medical Necessity Assessment

The American Society of Anesthesiologists (ASA) practice guidelines recommend spinal cord stimulation for CRPS patients who have not responded to other therapies, including a 41-year-old female with chronic pain syndrome and low back pain, who has failed conservative treatments such as epidural steroid injections, physical therapy, and activity modification 1, 2
The ASA guidelines state that spinal cord stimulation may be considered for patients with CRPS, peripheral neuropathic pain, and other selected conditions, and mandate that a spinal cord stimulation trial should be performed before permanent implantation, which was completed in this case 1, 2
A successful spinal cord stimulator trial with documented significant pain relief, including complete relief of symptoms on one side and decreased reaction on the other, is a strong indicator for permanent implantation 1, 2

Hardware-related complications, such as lead migration and connection issues, and infection risk, reported in approximately 10-29% of cases in some studies, are potential complications of dorsal column stimulator implantation 3, 4
The potential need for revision surgery and shared decision-making, including discussion of these potential complications, are important considerations for patients undergoing dorsal column stimulator implantation 1, 2, 3, 4