POLICY STATEMENT NANS Training Requirements for Spinal Cord Stimulation Devices: Selection, Implantation, and Follow-up Jaimie M. Henderson, MD* · Robert M. Levy, MD, PhD † · Marshall D. Bedder, MD, FRCP ‡ · Peter S. Staats, MD, MBA § · Konstantin V. Slavin, MD ¶ · Lawrence R. Poree, MD, MPH, PhD †† · Richard B. North, MD ‡‡,§§ *Stanford University School of Medicine, Stanford, CA, USA; † Feinberg School of Medicine, Northwestern University, Chicago, IL, USA; ‡ Bedder Medicine Consulting, Poulsbo, WA, USA; § Departments of Anesthesiology and Critical Care Medicine and Oncology, Johns Hopkins University, Baltimore, MD, USA; ¶ Department of Neurosurgery, University of Illinois at Chicago, Chicago, IL, USA; †† Pain Clinic of Monterey Bay, Aptos, CA, USA; ‡‡ LifeBridge Health Brain & Spine Institute, Baltimore, MD, USA; and §§ Johns Hopkins University School of Medicine, Baltimore, MD, USA Introduction Spinal cord stimulation (SCS) has been used since the late 1960s as a treatment for chronic neuropathic pain. Approximately 4000 SCS systems are implanted each year in the United States. Over the past 15 years, more than 60,000 U.S. patients have undergone SCS surgery, many with very successful results. It has become clear, however, that SCS outcomes are heavily influenced by physician expertise in patient selection, implant technique, and follow-up care. Despite the large number of implants performed, no stan- dards have been developed for training or expertise in SCS. Many different medical and surgical specialties participate in patient selection, implantation, and follow-up, including neurosurgeons, anesthesiologists, physiatrists, neurologists, orthopedic surgeons, and others. Core knowledge and train- ing in SCS can differ widely among specialties, including varying degrees of familiarity with the implantation of SCS devices and management of SCS patients. Objectives of Policy Statement Given the marked differences in training for each disci- pline involved in SCS, the North American Neuromodula- tion Society (NANS) believes that uniform guidelines for training and competency are critically important to stan- dardize core knowledge across these multiple disparate spe- cialties. In response to this need for standardization, a committee was formed to develop training requirements for SCS patient selection, implantation, and follow-up care. The committee decided to base this policy statement on the successful implementation of training requirements for interventional procedures in other specialties (1,2). The NANS believes that this policy statement will help establish guidelines for training physicians in SCS that are applicable regardless of medical or surgical discipline, and that it might also be of help to medical licensure boards and hospital accreditation committees. Background Spinal cord stimulation for the treatment of chronic pain was first introduced in 1967. The earliest devices consisted of individual electrodes which were implanted in the sub- dural space over the dorsal surface of the spinal cord. Since a laminectomy and dural opening were required, these procedures were performed exclusively by neurosurgeons. Submitted: March 9, 2009; Accepted: March 11, 2009. Address correspondence and reprint requests to: Jaimie M. Henderson, MD, Stanford University School of Medicine, 300 Pasteur Drive, Edwards Bldg./R-227, Stanford, CA 94305, USA. Email: henderj@stanford.edu For more information on author guidelines, an explanation of our peer review process, and conflict of interest informed consent policies, please go to http://www.wiley.com/bw/submit.asp?ref=1094-7159&site=1 NEUROMODULATION: TECHNOLOGY AT THE NEURAL INTERFACE Volume 12 • Number 3 • 2009 http://www.blackwell-synergy.com/loi/ner © 2009 International Neuromodulation Society