ISASS Issues NeuroStim Guidelines

The International Society for the Advancement of Spine Surgery (ISASS) has just issued a comprehensive set of guidelines for treating low back pain patients with restorative neurostimulation therapies.

The new guideline cover:

• The definition of mechanical chronic low back pain
• How it presents clinically
• The prevalence and nuance of low back pain
• The critical role muscles play in generating low back pain
• How mechanism of action for restorative neurostimulation
• Patient selection for neurostim treatment
• Clinical evidence for neurostimulation
• Reimbursement landscape including the relevant ICD-10 codes?
• Costs, direct and indirect.

The authors of the study were:

• Morgan Lorio, M.D., FACS with the Orthopedic Laser and Spine Center at LSU,
• Kai-Uwe Lewandrowski, M.D., with the Center for Advanced Spinal Surgery in Tucson,
• Domagoj Coric, M.D., neurosurgeon, Carolina Neurosurgery and Spine Associates,
• Frank Phillips, M.D., Director of Spine Surgery at Rush Medical and
• Christopher I. Shaffrey, M.D., neurosurgeon at the Duke Spine Center

These guidelines come at a most propitious moment. Interventional pain management is, perhaps, the fastest growing sector in the treatment of back pain. Caregivers, notably surgeons and interventional pain specialists, need a comprehensive and authoritative study to help guide the use of these interesting and promising therapies.

For sure, chronic low back pain (LBP) is a diverse and often debilitating experience for a significant proportion of the U.S. population.

Conservative management is step one and remains the predominant care pathway. However, for many patients, conservative care falls too short of symptom relief.

Restorative neurostimulation is a new and promising technique for patients who have exhausted traditional care paradigms.

According to the authors: “Restorative neurostimulation for chronic mechanical LBP is supported by several clinical studies that show robust and durable clinical effects over the pretreatment condition.”

“The totality of evidence suggests that in a well-selected patient population who have exhausted conventional care paradigms, the potential benefits outweigh the risks and costs. These patients tend to be exposed to multiple therapies with limited durability, resulting in a continuous cycle of high-cost health care utilization.”

“Restorative neurostimulation should be considered for clinically appropriate patients who have exhausted reasonable conservative approaches.”

To read the guidelines yourself, here is a link.