The Neurostimulation Appropriateness Consensus Committee (NACC): Recommendations for surgical technique for spinal cord stimulation


Timothy R. Deer, The Spine and Nerve Centers of the Virginias, Charleston, WV, USA. Electronic address:
Marc A. Russo, Hunter Pain Specialists, Newcastle, New South Wales, Australia.
Jay S. Grider, UKHealthCare Pain Services, Department of Anesthesiology, University of Kentucky College of Medicine, Lexington, KY, USA.
Jason Pope, Evolve Restorative Center, Santa Rosa, CA, USA.
Philippe Rigoard, Department of Spine Surgery and Neuromodulation, PRISMATICS Lab, Poitiers University Hospital, Poitiers, France.
Jonathan M. Hagedorn, Department of Anesthesiology and Perioperative Medicine, Division of Pain Medicine, Mayo Clinic, Rochester, MN, USA.
Ramana Naidu, California Orthopedics & Spine, Larkspur, CA, USA.
Denis G. Patterson, Nevada Advanced Pain Specialists, Reno, NV, USA.
Derron Wilson, Goodman Campbell Brain and Spine, Department of Neurological Surgery, Indiana University School of Medicine, Indianapolis, IN, USA.
Timothy R. Lubenow, Department of Anesthesiology, Rush University Medical Center, Chicago, IL, USA.
Asokumar Buvanendran, Department of Anesthesiology, Rush University Medical Center, Chicago, IL, USA.
Samir J. Sheth, Department of Anesthesiology and Pain Medicine, University of California, Davis, Davis, CA, USA.
Rany Abdallah, Center for Interventional Pain and Spine, Milford, DE, USA.
N Nick Knezevic, Advocate Aurora HealthFollow
Stefan Schu, Leitender Arzt Neuromodulation, Neurochirurgie, Sana Kliniken Duisburg GmbH, Duisburg, Germany.
Harold Nijhuis, Department of Anesthesiology, St. Antonius Hospital, Nieuwegein, The Netherlands.
Pankaj Mehta, Pain Specialists of America, Austin, TX, USA.
Ricardo Vallejo, Millennium Pain Center, Bloomington, IL, USA.
Jay M. Shah, SamWell Institute for Pain Management, Colonia, NJ, USA.
Michael E. Harned, UKHealthCare Pain Services, Department of Anesthesiology, University of Kentucky College of Medicine, Lexington, KY, USA.
Navdeep Jassal, Spine & Pain Institute of Florida, Lakeland, FL, USA.
Jose Manuel Gonzalez, Hospital Clínico Universitario Virgen de la Victoria, Servicio Andaluz de Salud, Málaga, Spain.
Thomas P. Pittelkow, Division of Pain Medicine, Department of Anesthesiology and Perioperative Medicine, Mayo Clinic College of Medicine and Science, Rochester, MN, USA.
Shachi Patel, Delmarva Spine and Pain Center, Newark, DE, USA.
Stana Bojanic, Department of Neurosurgery, Oxford University Hospitals NHS Foundation Trust, Oxford, England, UK.
Kenneth Chapman, Department of Anesthesiology, Perioperative Care, and Pain Medicine, The Pain and Spine Institute of New York, New York, NY, USA.
Natalie Strand, Department of Anesthesiology, Division of Pain Medicine, Mayo Clinic, Phoenix, AZ, USA.
Alexander L. Green, Nuffield Department of Surgical Sciences, Oxford University, Oxford, England, UK.
Peter Pahapill, Functional Neurosurgery, Medical College of Wisconsin, Milwaukee, WI, USA.
Alessandro Dario, Department of Neurosurgery, ASST Settelaghi, Insubria University, Varese, Italy.
Fabian Piedimonte, Fundación CENIT-University of Buenos Aires, Buenos Aires, Argentina.


Advocate Illinois Masonic Medical Center


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.

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