63650 Percutaneous implantation of neurostimulator electrode array, epidural

Name of the Procedure:

Percutaneous Implantation of Neurostimulator Electrode Array, Epidural

Summary

This procedure involves the insertion of a specialized electrode array into the epidural space of the spine using a minimally invasive technique. The electrode array is connected to a neurostimulator device, which sends electrical impulses to the spinal cord to help manage chronic pain.

Purpose

The procedure addresses chronic pain conditions that are not well-managed by medication or other treatments. The goal is to reduce pain levels and improve the patient's quality of life by interrupting pain signals before they reach the brain.

Indications

This procedure is indicated for patients suffering from conditions such as:

• Chronic back pain
• Failed back surgery syndrome (FBSS)
• Complex regional pain syndrome (CRPS)
• Peripheral neuropathy Patients who have not responded adequately to conservative treatments like physical therapy or medication may be candidates.

Preparation

• Patients will be instructed to fast for several hours before the procedure.
• Certain medications, especially blood thinners, may need to be adjusted or stopped.
• Diagnostic tests such as MRI or CT scans may be required to guide the electrode placement.

Procedure Description

1. The patient is positioned face-down on the procedure table.
2. Local anesthesia is administered to numb the area.
3. A small incision is made in the skin over the targeted area of the spine.
4. Using fluoroscopic (X-ray) guidance, a needle is inserted into the epidural space.
5. The electrode array is threaded through the needle into the epidural space and positioned along the spinal cord.
6. The electrode array is connected to an external neurostimulator device to test its effectiveness and adjust settings.
7. If successful, the electrode array is secured, and the incision is closed.
8. The external device may later be replaced with a permanent, implanted neurostimulator during a follow-up procedure.

Duration

The procedure typically takes 1 to 2 hours.

Setting

The procedure is usually performed in a hospital or an outpatient surgical center.

Personnel

• Pain management specialists or spinal surgeons
• Nurses
• Anesthesiologists

Risks and Complications

• Infection at the incision site
• Bleeding
• Nerve damage
• Electrode migration
• Device malfunction
• Allergic reactions to materials used

Benefits

• Significant reduction in chronic pain
• Improved ability to perform daily activities
• Reduced dependence on pain medications Patients may start to experience pain relief within days to weeks after the procedure.

Recovery

• Post-procedure, patients are monitored for a few hours.
• Instructions on care for the incision site and activity restrictions are provided.
• Follow-up appointments are necessary to monitor progress and adjust settings.
• Full recovery and optimal pain relief may take several weeks.

Alternatives

• Conservative treatments such as physical therapy, medication, and lifestyle changes.
• Alternative interventional procedures like steroid injections or radiofrequency ablation.
• Surgical options like spinal fusion or decompression surgery. Each alternative has its pros and cons, and effectiveness varies per individual.

Patient Experience

• Patients may feel slight pressure or a mild tingling sensation during electrode placement.
• Post-procedure discomfort is typically mild and managed with pain medication.
• Patients may need assistance with daily activities initially but should gradually return to normal function.

This markdown text offers a comprehensive overview of the percutaneous implantation of a neurostimulator electrode array in the epidural space, aimed at educating patients and healthcare providers alike.