The Optimal Patient Profile and Appropriate Role of Spinal Cord Stimulation (SCS) for Patients with Persistent Spinal Pain Syndrome-Type 1 (PSPS-T1) Not Suitable for Spine Surgery: A European Modified Delphi Consensus.

Purpose: Chronic lower back pain (CLBP) is a debilitating condition, and a leading cause of disability associated with significant negative impacts on patients' quality of life (QoL) and mental health. In both Persistent Spinal Pain Syndrome Types 1 and 2 (PSPS-T1/2) patients, spinal cord stimulation (SCS) therapy has shown favorable outcomes including improved QoL and patient satisfaction, reductions in opioid use, and an acceptable safety profile. This consensus aimed to define the PSPS-T1 patient profile for SCS to maximize its benefits in clinical settings and allow budget holders to quantify the patient population and allocate budget accordingly. Methods: This study used a modified Delphi methodology. A literature review was conducted, followed by multidisciplinary steering group discussions that resulted in the development of 32 statements under five key domains. These statements, along with a four-point Likert scale, were incorporated into a survey distributed across seven European countries to 144 healthcare professionals experienced in pain management. The respondents included orthopedic surgeons (n=50), pain specialists (n=48), and neurosurgeons (n=46). The consensus agreement threshold was set at 75%. Results: Consensus was achieved for 30 of the 32 statements, with 11 statements (34%) reaching ≥90% agreement. Two statements did not achieve consensus. Based on the consensus achieved in the study, an algorithm is proposed to assist in patient selection for SCS. Conclusion: This consensus provides recommendations on optimal patient profiles, referral processes, diagnostic procedures, and a decision-making algorithm for PSPS-T1 patients who are ineligible for spine surgery in Europe.