64581 Incision for implantation of neurostimulator electrode array; sacral nerve (transforaminal placement)

Name of the Procedure:

Incision for implantation of neurostimulator electrode array; sacral nerve (transforaminal placement)

Summary

This procedure involves making an incision to implant a neurostimulator electrode array near the sacral nerves through the foramina (openings in the sacrum). It aims to modulate nerve activity to treat chronic pain or urinary and bowel dysfunction.

Purpose

The primary goal is to alleviate chronic pain or improve urinary and bowel control by stimulating the sacral nerves. It's often used for conditions unresponsive to other treatments.

Indications

• Chronic pelvic pain
• Fecal incontinence
• Urinary incontinence or urgency/frequency syndromes
• Neuropathic pain involving the lower abdomen or genital region

Preparation

• Patients may be required to fast for a certain number of hours before the procedure.
• Adjustments to medications, such as blood thinners, might be necessary.
• Pre-procedural imaging, like MRI or CT scans, to plan the electrode placement.

Procedure Description

1. Anesthesia: The patient is given local or general anesthesia.
2. Incision: A small incision is made near the sacrum.
3. Electrode Placement: Using fluoroscopic guidance, the electrode array is inserted through the foramina and positioned near the sacral nerves.
4. Testing: The leads are connected to an external neurostimulator to ensure correct placement and proper nerve stimulation.
5. Implantation: Once confirmed, the leads are connected to a permanent neurostimulator device, which is implanted subcutaneously.

Duration

The procedure typically takes between 1 to 2 hours.

Setting

Performed in a hospital or surgical center, often in an outpatient setting.

Personnel

• Surgeon (often a neurosurgeon or urologist)
• Anesthesiologist
• Surgical nurses
• Radiologic technologist (for imaging support)

Risks and Complications

• Infection
• Bleeding
• Lead migration or damage
• Pain at the incision site
• Allergic reactions to anesthesia
• Rare risks include nerve damage or device malfunction

Benefits

• Potential rapid relief from chronic pain
• Improvement in urinary and bowel control
• Enhanced quality of life by reducing symptoms that interfere with daily activities

Recovery

• Patients might go home the same day or after an overnight stay.
• Instructions include wound care, activity restrictions, and follow-ups for device programming.
• Full recovery might take a few weeks, with gradual resumption of normal activities.

Alternatives

• Medications (e.g., analgesics, antispasmodics)
• Physical therapy
• Lifestyle modifications
• Other surgical interventions such as bladder augmentation or nerve resection

Patient Experience

• Patients might experience soreness at the incision site and temporary discomfort during device adjustment.
• Pain management typically includes prescribed pain relievers.
• Many patients report improved symptoms within a few weeks after the procedure.