63688 Revision or removal of implanted spinal neurostimulator pulse generator or receiver

Name of the Procedure:

Revision or Removal of Implanted Spinal Neurostimulator Pulse Generator or Receiver

Summary

This procedure involves either adjusting (revision) or completely removing an implanted device that is used to manage chronic pain or other neurological conditions by delivering electrical impulses to the spinal cord.

Purpose

The implanted spinal neurostimulator is used to relieve chronic pain or treat other neurological issues. The revision might be necessary to improve the device's performance or replace malfunctioning components, while removal might be required if the device is no longer effective or causes complications.

Indications

• Chronic pain unrelieved by the current neurostimulator
• Device malfunction or failure
• Infections or complications at the implant site
• Patient's desire to discontinue neurostimulation therapy
• Changes in the patient's condition necessitating either adjustment or removal of the device

Preparation

• Fasting for at least 8 hours before the procedure
• Adjustments to medications, as advised by the healthcare provider
• Preoperative assessment including blood tests and imaging studies

Procedure Description

1. Anesthesia: The patient is given general or local anesthesia to ensure comfort.
2. Incision: A small incision is made at the site of the implanted device.
3. Revision:
   • The surgeon locates the pulse generator or receiver.
   • Adjustments or replacements are made.
   • The device is tested to ensure proper functioning.
4. Removal:
   • The surgeon carefully detaches the device from its leads.
   • The pulse generator or receiver is completely removed.
5. Closure: The incision is closed with sutures and covered with a sterile dressing.

Duration

The procedure typically takes between 1 to 2 hours, depending on whether it involves revision or removal.

Setting

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

Personnel

• Surgeon (usually a neurosurgeon or pain specialist)
• Nurse(s)
• Anesthesiologist (if general anesthesia is used)

Risks and Complications

• Infection at the site of the incision
• Bleeding or hematoma
• Damage to surrounding tissues or nerves
• Incomplete relief of symptoms
• Complications related to anesthesia

Benefits

• Potential improvement in symptom management
• Reduction in chronic pain or neurological symptoms
• Resolution of complications related to the initial implant

Recovery

• Post-procedure monitoring for a few hours
• Pain management with medications
• Instructions on incision care and activity restrictions
• Follow-up appointments to monitor recovery and device function (if revised)

Alternatives

• Medication management
• Physical therapy
• Different types of neuromodulation devices
• Surgical interventions

Patient Experience

• The patient may experience soreness at the incision site.
• Pain relief is managed with medications.
• Most patients can return to normal activities within a few days to weeks, with specific guidance from their healthcare provider on any activity restrictions or necessary follow-up care.