The Neurostimulation Appropriateness Consensus Committee (NACC): Recommendations for Surgical Technique for Spinal Cord Stimulation

Timothy R Deer; Marc A Russo; Jay S Grider; Jason Pope; Philippe Rigoard; Jonathan M Hagedorn; Ramana Naidu; Denis G Patterson; Derron Wilson; Timothy R Lubenow; Asokumar Buvanendran; Samir J Sheth; Rany Abdallah; N Nick Knezevic; Stefan Schu; Harold Nijhuis; Pankaj Mehta; Ricardo Vallejo; Jay M Shah; Michael E Harned; Navdeep Jassal; Jose Manuel Gonzalez; Thomas P Pittelkow; Shachi Patel; Stana Bojanic; Kenneth Chapman; Natalie Strand; Alexander L Green; Peter Pahapill; Alessandro Dario; Fabian Piedimonte; Robert M Levy

doi:10.1016/j.neurom.2021.10.015

The Neurostimulation Appropriateness Consensus Committee (NACC): Recommendations for Surgical Technique for Spinal Cord Stimulation

Neuromodulation. 2022 Jan;25(1):1-34. doi: 10.1016/j.neurom.2021.10.015.

Authors

Timothy R Deer¹, Marc A Russo², Jay S Grider³, Jason Pope⁴, Philippe Rigoard⁵, Jonathan M Hagedorn⁶, Ramana Naidu⁷, Denis G Patterson⁸, Derron Wilson⁹, Timothy R Lubenow¹⁰, Asokumar Buvanendran¹⁰, Samir J Sheth¹¹, Rany Abdallah¹², N Nick Knezevic¹³, Stefan Schu¹⁴, Harold Nijhuis¹⁵, Pankaj Mehta¹⁶, Ricardo Vallejo¹⁷, Jay M Shah¹⁸, Michael E Harned³, Navdeep Jassal¹⁹, Jose Manuel Gonzalez²⁰, Thomas P Pittelkow²¹, Shachi Patel²², Stana Bojanic²³, Kenneth Chapman²⁴, Natalie Strand²⁵, Alexander L Green²⁶, Peter Pahapill²⁷, Alessandro Dario²⁸, Fabian Piedimonte²⁹, Robert M Levy³⁰

Affiliations

¹ The Spine and Nerve Centers of the Virginias, Charleston, WV, USA. Electronic address: doctdeer@aol.com.
² Hunter Pain Specialists, Newcastle, New South Wales, Australia.
³ UKHealthCare Pain Services, Department of Anesthesiology, University of Kentucky College of Medicine, Lexington, KY, USA.
⁴ Evolve Restorative Center, Santa Rosa, CA, USA.
⁵ Department of Spine Surgery and Neuromodulation, PRISMATICS Lab, Poitiers University Hospital, Poitiers, France.
⁶ Department of Anesthesiology and Perioperative Medicine, Division of Pain Medicine, Mayo Clinic, Rochester, MN, USA.
⁷ California Orthopedics & Spine, Larkspur, CA, USA.
⁸ Nevada Advanced Pain Specialists, Reno, NV, USA.
⁹ Goodman Campbell Brain and Spine, Department of Neurological Surgery, Indiana University School of Medicine, Indianapolis, IN, USA.
¹⁰ Department of Anesthesiology, Rush University Medical Center, Chicago, IL, USA.
¹¹ Department of Anesthesiology and Pain Medicine, University of California, Davis, Davis, CA, USA.
¹² Center for Interventional Pain and Spine, Milford, DE, USA.
¹³ Department of Anesthesiology and Surgery at University of Illinois, Department of Anesthesiology, Advocate Illinois Masonic Medical Center, Chicago, IL, USA.
¹⁴ Leitender Arzt Neuromodulation, Neurochirurgie, Sana Kliniken Duisburg GmbH, Duisburg, Germany.
¹⁵ Department of Anesthesiology, St. Antonius Hospital, Nieuwegein, The Netherlands.
¹⁶ Pain Specialists of America, Austin, TX, USA.
¹⁷ Millennium Pain Center, Bloomington, IL, USA.
¹⁸ SamWell Institute for Pain Management, Colonia, NJ, USA.
¹⁹ Spine & Pain Institute of Florida, Lakeland, FL, USA.
²⁰ Hospital Clínico Universitario Virgen de la Victoria, Servicio Andaluz de Salud, Málaga, Spain.
²¹ Division of Pain Medicine, Department of Anesthesiology and Perioperative Medicine, Mayo Clinic College of Medicine and Science, Rochester, MN, USA.
²² Delmarva Spine and Pain Center, Newark, DE, USA.
²³ Department of Neurosurgery, Oxford University Hospitals NHS Foundation Trust, Oxford, England, UK.
²⁴ Department of Anesthesiology, Perioperative Care, and Pain Medicine, The Pain and Spine Institute of New York, New York, NY, USA.
²⁵ Department of Anesthesiology, Division of Pain Medicine, Mayo Clinic, Phoenix, AZ, USA.
²⁶ Nuffield Department of Surgical Sciences, Oxford University, Oxford, England, UK.
²⁷ Functional Neurosurgery, Medical College of Wisconsin, Milwaukee, WI, USA.
²⁸ Department of Neurosurgery, ASST Settelaghi, Insubria University, Varese, Italy.
²⁹ Fundación CENIT-University of Buenos Aires, Buenos Aires, Argentina.
³⁰ International Neuromodulation Society, Neurosurgical Services, Clinical Research, Anesthesia Pain Care Consultants, Tamarac, FL, USA.

PMID: 35041578
DOI: 10.1016/j.neurom.2021.10.015

Abstract

Introduction: The field of neurostimulation for the treatment of chronic pain is a rapidly developing area of medicine. Although neurostimulation therapies have advanced significantly as a result of technologic improvements, surgical planning, device placement, and postoperative care are of equal importance to optimize outcomes. This Neurostimulation Appropriateness Consensus Committee (NACC) project intends to provide evidence-based guidance for these often-overlooked areas of neurostimulation practice.

Materials and methods: Authors were chosen based on their clinical expertise, familiarity with the peer-reviewed literature, research productivity, and contributions to the neuromodulation literature. Section leaders supervised literature searches of MEDLINE, BioMed Central, Current Contents Connect, Embase, International Pharmaceutical Abstracts, Web of Science, Google Scholar, and PubMed from the last NACC publication in 2017 to the present. Identified studies were graded using the United States Preventive Services Task Force criteria for evidence and certainty of net benefit. Recommendations are based on evidence strength and consensus when evidence was scant.

Results: This NACC project provides guidance on preoperative assessment, intraoperative techniques, and postoperative management in the form of consensus points with supportive evidence. These results are based on grade of evidence, strength of consensus, and expert opinion.

Conclusions: The NACC has given guidance for a surgical plan that encompasses the patient journey from the planning stage through the surgical experience and postoperative care. The overall recommendations are designed to improve efficacy and the safety of patients undergoing these neuromodulation procedures and are intended to apply throughout the international community.

Keywords: Best practices; consensus; neurostimulation; spinal cord stimulation; surgical technique.

Publication types

Review

MeSH terms

Chronic Pain* / therapy
Consensus
Humans
Spinal Cord Stimulation*