Name of the Procedure:

Implantation, Revision, or Repositioning of Tunneled Intrathecal or Epidural Catheter for Long-Term Medication Administration via an External Pump or Implantable Reservoir/Infusion Pump (without Laminectomy)

Summary

This procedure involves placing, adjusting, or moving a catheter (a thin, flexible tube) into the intrathecal or epidural space (areas around the spinal cord) to deliver medication directly to the spine. The catheter is connected to an external pump or an implantable infusion pump, which administers medication continuously over a long period without the need for repeated injections.

Purpose

The procedure is done to manage chronic pain or severe spasticity that does not respond well to oral medications. The primary goal is to provide effective symptom control and improve the quality of life by delivering medication directly to the site of action, thus potentially reducing side effects and increasing efficacy.

Indications

• Chronic pain conditions such as cancer pain, failed back surgery syndrome, or complex regional pain syndrome.
• Severe spasticity resulting from conditions like multiple sclerosis or spinal cord injuries.
• Patients who have not responded to conventional pain or spasticity management treatments.

Preparation

• Fasting for 6-8 hours before the procedure.
• Adjustments to current medication regimes as per doctor's advice.
• Blood tests or imaging studies might be required to assess overall health and the anatomy of the spine.

Procedure Description

1. The patient is positioned to allow access to the spinal area.
2. Local anesthesia and sedation are administered for comfort.
3. A small incision is made near the spine to insert the catheter into the intrathecal or epidural space.
4. The catheter is tunneled under the skin to an external pump or connected to an implantable infusion pump placed in another small incision.
5. The placement is confirmed using imaging techniques like fluoroscopy.
6. Incisions are closed with sutures or surgical glue.
7. The pump is programmed to deliver the medication at the required rate.

Duration

The entire procedure typically takes 1-2 hours.

Setting

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

Personnel

• Neurosurgeon or pain management specialist
• Anesthesiologist (if sedation is required)
• Surgical nurses
• Radiology technicians (for imaging guidance)

Risks and Complications

• Infection at the catheter or pump site
• Bleeding or hematoma formation
• Catheter displacement or blockage
• Cerebrospinal fluid leak
• Medication side effects if dosage is not accurately controlled

Benefits

• Effective pain or spasticity relief not achievable with oral medications
• Potential reduction in systemic medication side effects
• Improved quality of life and functional capability

Recovery

• Observation in a recovery room for a few hours post-procedure.
• Instructions on how to care for the incision sites.
• Avoid strenuous activities for a few weeks.
• Follow-up appointments to adjust medication dosage and check the system's function.
• Patients may experience some discomfort at incision sites, manageable with prescribed pain medication.

Alternatives

• Oral pain medications or muscle relaxants
• Epidural steroid injections
• Physical therapy and rehabilitation
• Spinal cord stimulation
• Each alternative has its own set of advantages and limitations, and the choice depends on individual patient factors and response to prior treatments.

Patient Experience

• Patients might feel slight pressure or discomfort during catheter insertion.
• Sedation or local anesthesia ensures minimal pain during the procedure.
• Post-procedure, there may be some soreness at the incision sites, typically managed with mild pain relievers.
• Regular follow-ups required to monitor and adjust medication delivery.