Insertion or replacement of spinal neurostimulator pulse generator or receiver, direct or inductive coupling
CPT4 code
Name of the Procedure:
Insertion or Replacement of Spinal Neurostimulator Pulse Generator or Receiver, Direct or Inductive Coupling. Common names: Spinal Neurostimulator Implant, SCS (Spinal Cord Stimulation) Pulse Generator Implant.
Summary
This procedure involves surgically placing a small device called a pulse generator or receiver near the spine. The device sends electrical signals to the spinal cord to alleviate chronic pain.
Purpose
The medical condition or problem it addresses:
- Chronic pain in the back, legs, or arms not relieved by other treatments.
The goals or expected outcomes of the procedure:
- To reduce pain and improve the quality of life for patients with chronic pain.
- To decrease dependency on pain medications.
Indications
Specific symptoms or conditions that warrant the procedure:
- Persistent, severe pain that has not responded to conservative treatments like medication, physical therapy, or injections.
Patient criteria or factors that make the procedure appropriate:
- Patients with a confirmed diagnosis of chronic pain.
- Patients who have responded positively to a trial stimulation.
Preparation
Pre-procedure instructions for the patient:
- You may be asked to fast for several hours before surgery.
- Medications may need to be adjusted, specifically anticoagulants and antiplatelets.
Any diagnostic tests or assessments required beforehand:
- MRI or CT scans to visualize the spine.
- Psychological evaluation to ensure suitability for the implant.
Procedure Description
Detailed step-by-step explanation:
- The patient is positioned on the operating table, and the surgical site is sterilized.
- An incision is made near the spine.
- Leads (wires) connected to the pulse generator are placed near specific nerves.
- The pulse generator is implanted under the skin, typically in the lower back or abdomen.
- The incision is closed with sutures.
Tools, equipment, or technology used:
- Pulse generator, leads, surgical instruments, fluoroscopy (for imaging guidance).
Anesthesia or sedation details:
- General anesthesia or local anesthesia with sedation.
Duration
How long the procedure typically takes:
- Approximately 1 to 2 hours.
Setting
Where the procedure is performed:
- Hospital or outpatient surgical center.
Personnel
Healthcare professionals involved:
- Surgeons, anesthesiologists, surgical nurses, and possibly pain management specialists.
Risks and Complications
Common and rare risks associated with the procedure:
- Infection, bleeding, nerve damage, hardware malfunction, and cerebrospinal fluid leak.
Possible complications and their management:
- Device infection requiring removal, lead migration necessitating repositioning, reprogramming of the device for optimal pain relief.
Benefits
Expected benefits and how soon they might be realized:
- Significant pain reduction often noticeable within a few days to weeks.
- Improved functionality and quality of life.
- Potential reduction in the use of pain medications.
Recovery
Post-procedure care and instructions:
- Keep the incision clean and dry.
- Avoid strenuous activities and heavy lifting for several weeks.
- Follow-up appointments to monitor healing and device function.
Expected recovery time and any restrictions:
- Recovery time ranges from a few days to a few weeks.
- Activity restrictions generally last 4 to 6 weeks.
Alternatives
Other treatment options available:
- Pain medications, physical therapy, nerve blocks, or radiofrequency ablation.
Pros and cons of alternatives:
- Medications may have systemic side effects; physical therapy might be less effective for severe pain.
- Neurostimulator implantation offers a targeted and drug-free pain relief solution.
Patient Experience
What the patient might feel or experience during and after the procedure:
- Mild discomfort or pain at the incision site.
- Possible tingling sensations as the device settings are adjusted.
- Pain relief might be immediate but can take a few weeks for full effect.
Pain management and comfort measures:
- Pain medications and anti-inflammatory drugs as needed.
- Follow-up visits for device programming adjustments and pain assessment.