63655 Laminectomy for implantation of neurostimulator electrodes, plate/paddle, epidural

Name of the Procedure:

Laminectomy for implantation of neurostimulator electrodes (plate/paddle), epidural
Common names: Spinal cord stimulator implantation, Neurostimulator paddle implantation

Summary

A laminectomy to implant neurostimulator electrodes involves removing a small portion of the vertebra to place electrodes on the epidural space of the spinal cord. This helps manage chronic pain by delivering electrical impulses that modulate pain signals before they reach the brain.

Purpose

This procedure addresses chronic pain conditions that have not responded to other treatments. The goal is to reduce pain and improve quality of life by interrupting pain signals.

Indications

• Chronic and severe back or limb pain
• Failed back surgery syndrome (FBSS)
• Complex Regional Pain Syndrome (CRPS)
• Nerve pain unresponsive to conservative treatments such as medication or physical therapy

Preparation

• Fasting for at least 8 hours before the procedure
• Stopping certain medications, such as blood thinners, as advised by the doctor
• Undergoing pre-operative assessments like MRI or CT scans to identify the exact location for electrode placement
• Arranging post-procedure transportation and care

Procedure Description

1. The patient is given general anesthesia or sedation.
2. A small incision is made in the back.
3. A laminectomy is performed to remove part of the vertebra.
4. A neurostimulator electrode (plate/paddle) is inserted into the epidural space of the spinal cord.
5. The electrodes are connected to an external pulse generator, which will be implanted in a later procedure.
6. The incision is closed, and the patient is taken to a recovery area.

Duration

Approximately 2-3 hours

Setting

Hospital or specialized surgical center

Personnel

• Neurosurgeon or spinal surgeon
• Anesthesiologist
• Surgical nurse
• Radiologic technician (for intraoperative imaging)

Risks and Complications

• Infection
• Bleeding
• Nerve damage
• Headache due to cerebrospinal fluid leakage
• Failure of the device to relieve pain
• Equipment malfunction

Benefits

• Significant reduction in chronic pain
• Improved mobility and quality of life
• Reduced dependency on pain medications
• Immediate and sustained pain relief

Recovery

• Patients may need to stay in the hospital overnight for observation.
• Pain at the incision site can be managed with medication.
• Limit heavy lifting and bending for a few weeks.
• Follow-up appointments to check electrode placement and adjust settings.

Alternatives

• Medication management
• Physical therapy
• Other types of nerve blocks or injections
• Alternative neurostimulation methods, such as percutaneous leads

Patient Experience

During the procedure, patients are under anesthesia and will not feel pain. Post-procedure, there may be mild discomfort at the incision site, manageable with prescribed pain relief. Patients will gradually resume normal activities but should heed any restrictions as guided by their healthcare provider. Follow-up care ensures optimal device settings for maximum pain relief.