also reported that their SCS placement population was 74% women in a study assessing the effectiveness of SCSs in the treatment of CRPS type 1. reported that 60.3% of SCS placements were performed in women. In a study of 4,536 patients undergoing paddle lead SCS for the treatment of chronic pain, Babu et al. This finding is consistent with other studies in the literature. Our results show that SCSs are predominantly implanted in white female patients within both insurance providers. The demographic makeup of SCS patients was another area of interest in this study. Coverage propensity may be an additional driving force behind the greater disproportion of Medicare paddle lead SCS utilization. , demonstrated than private-payer were less likely to receive coverage for SCS implantation for the management of low back pain when compared to patients covered by public providers. One potential source of disparity could be that Medicare patients are traditionally older patients who present at advanced stages of disease with high comorbidity burden and thus may be perceived as more optimal candidates for conservative and cost effective measures, such as SCS. However, this would be expected drive rates of SCS down in the Medicare population, the opposite of this study’s observation. demonstrated that overall cost-effectiveness of SCS was decreased among Medicare patients compared to private-payers, however, drew no association to utilization trends. Prior studies among differing surgical specialties have demonstrated that insurance status can be predictive of choice of surgical technique. Within all time intervals adjusted annual rates of paddle lead SCS among Medicare patients were greater than those among private-payers. While adjusted annual rates of both the private-payer and Medicare groups increased the 8-year period among, there was a noticeable disparity between the cohorts. demonstrated a 262% increase in SCS implantation in 2012 compared to a previous survey of pain medicine fellowship programs in 1999. Furthermore, a survey of 50 institutions by Gharibo et al. This study demonstrated that SCS placement was relatively stable over 14 years from 1993 to 2006, findings that contrast with results of the present study. using the National Inpatient Sample database. SCS trends have been reported in a similar study by Lad et al. Further query of the private-payer database showed that the proportion of SCS placement was highest amongst white patients (79.6%) and high proportions of SCS placements were performed by general acute care hospital specialist (29.4%), neurological surgeons (28.1%), orthopaedic spine surgeons (16.0%), and neurologists (12.6%) ( Table 1). 56.6% all providers) and lowest in the Northeastern US region (11.4% Medicare vs. The highest incidence of SCS placement was in the Southern United States (US) region (55.6% Medicare vs.

SCSs were placed in greater proportions in women (59.3% Medicare vs. Incidence of overall SCS placement was highest in ages 65–84 years (54.0%) amongst Medicare beneficiaries and all providers (52.9%) while SCS placement rates were highest in patients < 65 years old (56.8%) amongst private-payers. In total, 34,287 paddle lead SCS placements were identified in the Medicare (n= 31,352) and private-payer (n= 2,935) insurance databases from 2007 to 2014 ( Fig. However, to date, one has explored what effect these differences in providers have on annual incidence of SCS. Private-payers have shown to have lower overall costs following implantation while simultaneously less likely to receive SCS coverage approval when compared to their public counterparts. With the rising popularity of SCSs, the role insurance providers’ play in utilization has begun to garner attention. In a number of randomized controlled trials, SCSs have been shown to be more effective in the treatment of chronic pain in spine patients compared to CMM or reoperation. SCSs continue to gain acceptance amongst spine surgeons as a nonpharmacologic treatment option to address chronic back pain from failed back surgery syndrome and other pain pathologies such as complex regional pain syndrome (CRPS), where conservative medical management (CMM) therapies have failed.

The recent intersection between the health and economic burden of chronic back pain and the ongoing opioid epidemic has heightened the need for safer alternatives to treat chronic back pain. Since its introduction by Shealy et al in 1967, spinal cord stimulators (SCS) have gained a wide range of application amongst a number of medical specialties for neuropathic pain alleviation.

Dorsal column stimulator cpt