title: Spinal cord stimulation in Belgium: a nation-wide survey on the incidence, indications and therapeutic efficacy by the health insurer.
abstract: The present report describes a nation-wide survey on the incidence, the indications and the efficacy of spinal cord stimulation (SCS), as assessed by the Belgian health authorities. The direct motive for this survey was the rapidly growing expenditures resulting from the increasing use of SCS. Between 1983 and 1992, nearly 700 SCS devices were implanted for a population of less than 10 million inhabitants. The most common indication for SCS was failed back survey (61.4%). Whereas SCS was initially only performed in university teaching hospitals, it is now also widely practised in general hospitals. In 3 studies, the efficacy of SCS was assessed. In a first study, success was defined in terms of resumption of professional activities. After a mean follow-up of more than 1 year, less than 5% of the 147 patients treated with SCS had returned to work. A second study investigated the subjective evaluation of the therapy by the patient. Seventy patients with a mean follow-up of 3.5 years were studied. In 52% of the patients, the effect of SCS was judged as good to very good. Men scored better than women. In addition, the results obtained in the teaching hospitals were significantly better than those obtained in general hospitals. In a third study, the impact of psychiatric screening on patient selection was evaluated. Of the 100 candidates, 36 were withheld from implantation with a SCS device because of psychiatric contra-indications. Patients who had received a positive psychiatric advice showed a significantly better therapeutic outcome than patients for whom the psychiatrist had made reservations.
authors.affiliation: Department of Brain and Behaviour Research, Gasthuisberg, University of Leuven, LeuvenBelgium Department of Neurosurgery, Gasthuisberg, University of Leuven, LeuvenBelgium Department of Psychiatry, Sint-Rafaël, University of Leuven, LeuvenBelgium School of Public Health, University of Leuven, LeuvenBelgium National Alliance of Christian Benefit Societies, B-1040 BrusselsBelgium.
authors.forename: Ron C
authors.initials: RC
authors.lastname: Kupers
authors.forename: Rob
authors.initials: R
authors.lastname: Van den Oever
authors.forename: Boudewijn
authors.initials: B
authors.lastname: Van Houdenhove
authors.forename: Willem
authors.initials: W
authors.lastname: Vanmechelcn
authors.forename: Bernard
authors.initials: B
authors.lastname: Hepp
authors.forename: Bart
authors.initials: B
authors.lastname: Nuttin
authors.forename: Jan M
authors.initials: JM
authors.lastname: Gybels
mesh_terms: D000293:Adolescent; D000328:Adult; D017677:Age Distribution; D000368:Aged; D000369:Aged, 80 and over; D001530:Belgium; D002648:Child; D002908:Chronic Disease; D000075202:Contraindications; D003363:Cost Control; D004599:Electric Stimulation Therapy / Q000191:economics / Q000706:statistics & numerical data*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D001523:Mental Disorders / Q000150:complications; D008875:Middle Aged; D009313:National Health Programs / Q000191:economics; D059408:Pain Management; D017678:Sex Distribution; D013116:Spinal Cord / Q000502:physiology*; D016896:Treatment Outcome