title: Counting the costs: case management implications of spinal cord stimulation treatment for failed back surgery syndrome.
abstract: OBJECTIVE
  The purpose of this article is to review clinical and health economic evidence supporting the use of spinal cord stimulation (SCS) for failed back surgery syndrome (FBSS) and to discuss implications for case managers' decision making.
  
  
  METHODS
  Primary settings include hospital and home environments.
  
  
  CONCLUSIONS
  Patients with FBSS experience persistent or recurring pain in the lower back, legs, or both after one or more spinal surgeries. Surgical revision and nonsurgical FBSS therapies often result in minimal or no clinical improvement, and reoperations often result in more pain. The efficacy and safety of SCS have improved as a result of earlier intervention, technological advances, and increased awareness of SCS proper patient selection. A recent randomized controlled trial (RCT) demonstrated that at mean 3-year follow-up, SCS achieves significantly more pain relief and treatment satisfaction and lower opiate analgesic use than reoperation in patients with FBSS. Another RCT demonstrated that at 6-month follow-up, more patients with FBSS achieve pain relief, enhanced quality of life, improved functioning, and higher treatment satisfaction levels with SCS than with conventional medical management (CMM). Health-economic FBSS studies show that SCS is more cost-effective than CMM or reoperation. SCS is a well-established FBSS treatment option with demonstrated efficacy and cost-effectiveness in selected patients.
  
  
  CONCLUSIONS
  Case Managers should consider recommending SCS as one modality prior to reoperation in patients with FBSS who meet the clinical criteria for its appropriate use.
authors.affiliation: Department of Pain Management at Cleveland Clinic, USA.
authors.forename: Nagy
authors.initials: N
authors.lastname: Mekhail
authors.forename: Donald L
authors.initials: DL
authors.lastname: Wentzel
authors.forename: Robert
authors.initials: R
authors.lastname: Freeman
authors.forename: Hafsa
authors.initials: H
authors.lastname: Quadri
mesh_terms: D019090:Case Management / Q000191:economics*; D057186:Comparative Effectiveness Research; D003362:Cost-Benefit Analysis; D003657:Decision Making; D004599:Electric Stimulation Therapy; D055111:Failed Back Surgery Syndrome / Q000191:economics / Q000628:therapy*; D017048:Health Care Costs; D006801:Humans; D008159:Lumbar Vertebrae; D013116:Spinal Cord / Q000601:surgery*; D013119:Spinal Cord Injuries / Q000601:surgery / Q000628:therapy*; D013781:Texas; D017211:Treatment Failure