Spinal Cord Stimulation Guidelines and Consensus Statements: Systematic Review and Appraisal of Guidelines for Research and Evaluation II Assessment.

Abstract

Introduction: Multiple guidelines and consensus statements have been established for spinal cord stimulation (SCS) for pain, including patient selection, indications, techniques of stimulation, and details of the procedure. Here, we sought to critically evaluate guidelines and consensus statements to provide insight into existing gaps in the SCS literature to help guide future endeavors.

Materials and methods: We performed a comprehensive and systematic literature search of PubMed, Web of Science, and Scopus on SCS guidelines and consensus statements for pain from 2000 to September 2024 using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. The extracted variables included patient selection, efficacy of therapy, pre- and postoperative care, techniques, holding certain medications, complication and infection avoidance and management, and indications. Guidelines and consensus statements were systematically evaluated using the Appraisal of Guidelines for Research and Evaluation II (AGREE-II) tool.

Results: The literature search yielded 102 articles. Title, abstract, and full-text analysis determined that 19 articles addressed guidelines and consensus statements relevant to SCS therapy from 2014 to 2024. The 19 articles were systematically analyzed and independently scored by two authors using the AGREE-II instrument. The average global quality score was 5.6 of 7. Current SCS guidelines and consensus statements strongly emphasize evidence-based practice, patient selection, and perioperative management. Weaknesses and gaps include the lack of long-term data on SCS with new waveforms, recommendations on emerging indications, psychologic evaluations, and holistic outcomes.

Conclusion: Multiple guidelines and consensus statements attest to the field's commitment to high-quality, evidence-based practice and patient care. However, limitations and gaps remain. Updates on current guidelines should focus on long-term results, holistic assessment and outcomes, and new indications.