Can Injured Workers Obtain Spinal Cord Stimulation?

Yes. Although the Department of Labor & Industries may initially deny authorization for implanted spinal cord stimulation devices, the Board of Industrial Insurance Appeals and higher state courts may still order that the treatment be provided. 

In Washington State, the Department of Labor & Industries initially adopted a formal policy to automatically disapprove Spinal Cord Stimulation (SCS) procedures, effective 09/29/2008. The Washington State Health Technology Clinical Committee formally disapproved the use of Spinal Cord Stimulation to treat neuropathic pain on 10/22/2010. However, most private insurance carriers and Medicare covered the procedure for appropriate patients by no later than 2015. 

Eventually, under mounting pressure from medical and legal advocacy groups seeking to ensure that injured workers could receive highest-quality healthcare utilizing SCS, the HTCC undertook a review of these technologies beginning in August, 2023.

Draft findings and a Draft Decision were scheduled to be published on May 24, 2024, with a public comment period open thereafter. The draft recommendation was to provide coverage for failed back surgery syndrome; non-surgical refractory back pain, and painful diabetic neuropathy. HTCC’s draft recommendation was against coverage for SCS as a treatment for complex regional pain syndrome. The HTCC’s final evidence report can be seen here. The final findings and publication date was set as June 26, 2024.

What is Spinal Cord Stimulation?

Spinal Cord Stimulation involves using a mild electrical signal to block chronic pain signals that would otherwise travel up a patient’s spine to their brain. The interruption of that pain signal, called neuromodulation, helps some chronic pain patients exit a pain process in which the body first signals pain from a noxious circumstance and then the brain interprets that signal to convince the patient they are still in severe pain even if the noxious circumstance no longer exists. 

How Long Has Spinal Cord Stimulation Been Used?

The National Institutes of Health states that Dr. Normal Shealy first used Spinal Cord Stimulation successfully in 1967, with the first commercially-available Spinal Cord Stimulator introduced by Medtronic in 1968. It is now considered to be a “staple of chronic pain management for various conditions including failed back syndrome, chronic regional pain syndrome, refractory radiculopathy, and chronic post operative pain.”

In modern times, with greater awareness of the dangers of pharmacologic pain management, dorsal column spinal cord stimulation has become “a staple of interventional management of chronic pain.” Medicare approves the procedure for appropriate candidates.

Who Is A Proper Candidate for Spinal Cord Stimulation?

An Experienced Pain Management Specialist, Neurosurgeon, or other highly-qualified specialist physician will conduct a patient-specific evaluation. A temporary trial with an exterior placement of wires is utilized to confirm that a patient is a proper candidate and to determine the likely best stimulation pattern for the patient. If the trial exterior placement helps control the patient’s pain and increase daily activities, then longer-term implantation may proceed. 

Proper Candidates for Implantable Spinal Cord Stimulation may include those with chronic or intractable pain caused by:

• Failed Back Syndrome
• Non-Surgical Refractory Back Pain
• Diabetic Neuropathy
• Lumbosacral Arachnoiditis
• Nerve Root Injuries, Post-Surgical or Post-Traumatic, Including for Post-Laminectomy Syndrome (Failed Back Syndrome)
• Complex Regional Pain Syndrome
• Phantom Limb Syndrome Unresponsive to Other Medical Management
• End-Stage Peripheral Vascular Disease, Where Revascularization Cannot Be Accomplished
• Post-Herpetic Neuralgia
• Cauda Equina Injury
• Incomplete Spinal Cord Injury
• Plexopathy

Medicare considers Spinal Cord Stimulation to be “experimental or investigational” for all other indications. The Washington State HTCC has recommended similar criteria, but even when the Department of Labor & Industries disapproves an authorization request, the injured worker may still appeal.

Medicare pays for Permanent Implantation of a Spinal Cord Stimulator (SCS) if the patient has adequate documentation to support the physician’s recommendation, including that a patient should experience a successful trial associated with at least a 50% reduction of target pain, or a 50% reduction of analgesic medications, and show some element of functional improvement (excluding those with CRPS, for whom improvement can only be expected with longer term utilization than is available through a typical trial).

Again, Department of Labor & Industries criteria are similar, but injured workers should be aware that they can appeal any denial of coverage decision to a judge or jury.

Who Is Not A Proper Spinal Cord Stimulation Candidate?

Improper candidates for SCS may include those with:

• Major Psychiatric Disorders, including somatization
• No Partial Sparing of the Dorsal Column Fibers (Total Paraplegia) Of the Treated Area
• Severe Disease Likely to Interfere with Neuromodulation Procedures
• An Active and Untreated Substance Abuse Disorder
• Ongoing Requirement for Therapeutic Diathermy
• Severe Cognitive Impairment Preventing Informed Consent or Operating the Device

Who May Provide Spinal Cord Stimulation Procedures?

Spinal Cord Stimulation is only appropriate if the treating physician possesses training and expertise acquired within the framework of an accredited residency and/or fellowship program in the United States, or equivalent. This is not a procedure that can be performed by mid-level providers, Chiropractors or non-specialized physicians. 

Are There Risks to Spinal Cord Stimulation?

Yes, the complication rate ranges by study, from the easily-correctable all the way to further nerve injury, paralysis, need for further surgery, or even death in very rare cases. The treating specialist physician will advise their patient about these and other risks and then make a collaborative decision together with their patient about whether the potential benefits outweigh the potential risks. The Washington State HTCC primary ranking criteria for SCS list safety as “medium,” efficacy as “high,” and cost at “medium.”

What is the Success Rate of Spinal Cord Stimulation Treatment?

The Cleveland Clinic reports that “The success rate for spinal cord stimulators depends partly on the condition they are treating and the device type.” The Cleveland Clinic also reports that “about half of people see more than a 50% improvement in their pain.”

However, one potential downside is that some patients report decreasing effectiveness of spinal cord stimulation over time, meaning that initial success for some patients may not be durable as some patients would hope. The decision to proceed is a decision that requires careful thought and appropriate due diligence.

What Law Firm Fights for Spinal Cord Stimulation Treatment for Injured Washington Workers?

Washington Law Center is experienced in filing and winning appeals for all types of medical procedures sought by injured workers, including with respect to Spinal Cord Stimulation procedures. Please call Washington Law Center for a free consultation today.

Page author:  Spencer Parr, Partner and Experienced Litigator at Washington Law Center