A new study by the University of Sydney has found that surgically implanted spinal cord stimulators, used to treat lower back pain, are associated with high costs and a significant risk of reintervention surgery. The findings, published in the Medical Journal of Australia, suggest one in four patients who undergo spinal cord stimulator implantation require further invasive surgery, mostly within three years of the initial procedure.
Lower back pain remains the leading cause of disability worldwide, affecting more than 600 million people. In Australia, data from the Australian Institute of Health and Welfare indicates that four million people were living with back problems in 2022. These conditions accounted for over 1000 deaths and an estimated $3.4 billion in healthcare costs.
The research analysed data from five Australian private health insurers. Lead author Dr Caitlin Jones, a postdoctoral research associate at the School of Public Health and Institute of Musculoskeletal Health, said, “The median time to reintervention was only 17 months, which means patients and the healthcare system are taking on a lot of cost and risk for a device that has evidence that it is ineffective.”
Dr Jones added, “For people who had the device inserted as a trial only, the cost to the insurer was about $14,000. People who advanced to a permanent implant cost the insurer about $55,000, but there are some outliers we found where surgical costs associated with these devices exceeded half a million dollars per patient.”
Spinal cord stimulators are designed to send electrical signals to the spinal cord to block pain messages from reaching the brain. These devices typically have a battery life of around five years before needing replacement or recharge. Usage has grown steadily in Australia, with 5072 stimulators implanted in 2023–24.
However, several issues have been identified. A 2023 Cochrane Review found the devices no more effective than placebo. In 2024, an episode of ABC’s Four Corners revealed that 79 percent of adverse events related to stimulators were classified as “severe”, while 13 percent were “life threatening”.
“Our new study highlights the cost associated with these devices, on top of their track record of poor performance and risk of issues like infection, tearing the lining around the spinal cord, or even unexplained increases in pain,” said Dr Jones.
She added that the study likely underestimates the true scale of the issue: “The data wasn’t able to follow patients across insurers, which could have contributed to an underestimation of the reinterventions and cost per person. People who found the devices to be ineffective but chose to leave them in place but turned off, would not have been detected in this dataset.”
The study focused solely on reintervention frequency and cost. Dr Jones noted that reasons behind the continued prescription and implantation of stimulators remain unclear and will be the subject of future investigation.
Despite the concerns raised, Dr Jones said there are other ways to manage chronic back pain, “In 2023 the World Health Organization identified a range of effective therapies for managing chronic back pain. Effective options include education, exercise, cognitive behavioural therapy and medicines such as non-steroidal anti-inflammatory medicines.”
Dr Jones also highlighted newer therapies, “Recent Australian research has shown that sensorimotor retraining and cognitive functional therapy are also effective. Your healthcare providers should be able to give you advice on what is best for your personal situation.”
Dr Jones concluded, “Thankfully, Australia is at the forefront of back pain research, which is leading to safer, more effective therapies.”