Abstract ID: A22
Abstract Title: Spinal cord stimulation therapy practice patterns: The first nationwide analysis
Poster Type: Either
ABSTRACT BODY
Introduction:
Spinal cord stimulation (SCS) therapy has been shown to be an effective modality to control chronic pain.1 In addition to anesthesiologists, specialists in neurosurgery, neurology, orthopedic surgery, and physical medicine and rehabilitation utilize SCS as part of their treatment regimen for chronic pain. Although introduced by Shealy2 in 1967, controversy still exists regarding the indications for SCS, with no clear consensus for implementation. The goal of this nationwide survey was to assess the practice patterns utilized with SCS therapy by different specialty physicians.
Methods:
A 38-question survey was mailed to 1000 SCS implanters across the United States in April, 2003. The questionnaire was divided into four sections: (1) demographics of the implanter, (2) patient selection criteria, (3) product selection criteria, and (4) assessment of trial and permanent implantation indications and techniques. Physician responses were compared by specialty to determine the presence of practice pattern variances. Statistical significance between specialties regarding categorical and ordinate outcomes was assessed using chi-square tests of association or Fishers exact test. Wilcoxon rank-sum tests were used for percentage outcomes.
Results:
A total of 165 surveys were completed and analyzed. Anesthesiologists (AN) and neurosurgeons (NS) were the most frequent respondents. Regardless of specialty, the most common factor that limited the number of SCS trials and implants was the cost of the therapeutic modality and its associated reimbursement. AN most frequently place SCS trial leads in the lumbar region, while the most common site used for lead placement by NS is equally divided between the lumbar and thoracic regions. AN more frequently place sacral leads than NS (p<0.006). Physicians of both specialties place leads in the cervical region, on average, 15% of the time. For trial lead placement, both AN and NS use a single percutaneous lead most commonly. However, AN use a dual percutaneous lead more often than NS (p<0.001) who use a surgical paddle lead trial more often (p<0.001). AN always perform their own SCS trials, and perform trials for 35% of the NS. Conversely, NS nearly always perform their own permanent implantations, and do so in 15% of anesthesiologists practices. The majority of implanters identify a 0.7 implant to trial ratio as appropriate, and consider >50% pain relief as the most important indicator of a trial success. Manufacturers representatives most commonly program the implantable generator for AN, while NS most frequently program their own
Discussion:
Pain physicians from multiple specialties utilize SCS as part of their treatment regimen for chronic pain. This survey reveals that there are many similarities in practice patterns between specialties. In some areas, however, significant differences do exist between AN and NS. It is unknown at this time whether these variances affect patient outcome.
References:
1. North RB, et al: Neurosurgery 32:384-94, 1993.
2. Shealy CN, et al: Anesth Anal 46:489-91, 1967.
ATTACHED FILES
Reg Anesth Pain Med 2004; 29(2):A22