Medical Necessity for Spinal Cord Stimulator Trial in Postlaminectomy Syndrome

Indication and Evidence Base

• The American Society of Anesthesiologists guidelines recommend spinal cord stimulation for patients with persistent radicular pain who have not responded to other therapies 1
• Postlaminectomy syndrome (failed back surgery syndrome) with low back pain and significant radicular pain is an established indication for spinal cord stimulation when conservative treatments have failed 1

Patient Selection Criteria

• The patient is at least 6 months post-operative from his lumbar fusion surgery 1

Trial Procedure Rationale

• The requested procedures (63650 x2 for percutaneous electrode placement, L8680 x16 for the electrodes, and 95972 for electronic analysis) are appropriate for a comprehensive SCS trial 1

Expected Benefits

• For patients with postlaminectomy syndrome, SCS may provide better pain control than reoperation 2, 3
• Significant pain reduction during the trial period would be a strong indicator of long-term success with permanent implantation 1

Limitations and Considerations

• Some patients may experience diminishing effectiveness over time, potentially requiring system revision 4