63661 Removal of spinal neurostimulator electrode percutaneous array(s), including fluoroscopy, when performed

Name of the Procedure:

Removal of Spinal Neurostimulator Electrode Percutaneous Array(s), including Fluoroscopy, when Performed

Summary

This procedure involves removing electrodes that were previously implanted in the spine to provide nerve stimulation for pain relief. Fluoroscopy, a type of X-ray imaging, may be used to guide the process.

Purpose

The procedure addresses issues such as chronic pain management where the spinal neurostimulator has either failed to provide the desired relief, caused unwanted side effects, or is no longer needed. The goal is to safely remove the electrodes to alleviate side effects, address nonfunctionality, or prepare for alternative treatments.

Indications

• Ineffectiveness of the spinal neurostimulator in providing pain relief
• Infection at the implant site
• Electrode displacement or malfunctions
• Patient’s decision to discontinue neurostimulation therapy
• Complications such as spinal cord damage or severe pain

Preparation

• Fasting may be required prior to the procedure.
• Medication adjustments might be necessary; particularly blood thinners.
• Pre-procedure imaging and diagnostic tests to confirm the position of the electrodes.
• Discussing the procedure and signing consent forms with the healthcare provider.

Procedure Description

1. Preparation: The patient is brought to the surgical suite and prepped, including sterilization of the target area.
2. Anesthesia: Typically, local anesthesia and sedation are used, though general anesthesia may be required in some cases.
3. Fluoroscopy: The use of fluoroscopy provides real-time imaging to guide the safe removal of the electrode arrays.
4. Incision and Removal: A small incision is made over the previous implantation site. The electrodes are carefully extracted using special tools.
5. Closure: The incision site is closed with sutures or surgical glue and then bandaged.

Duration

The procedure typically takes about 1 to 2 hours, although this may vary based on individual circumstances.

Setting

Performed in a hospital, surgical center, or specialized outpatient clinic.

Personnel

• Neurosurgeon or spinal surgeon
• Anesthesiologist
• Surgical nurses
• Radiologic technologist (for fluoroscopy)

Risks and Complications

• Infection at the incision site
• Bleeding or hematoma formation
• Damage to surrounding tissues or nerves
• Pain or discomfort at the removal site
• Adverse reactions to anesthesia

Benefits

• Relief from side effects caused by the neurostimulator
• Resolution of complications related to the device
• Possibility to explore alternative pain management options Expected benefits can be realized shortly after recovery from the surgery.

Recovery

• Post-procedure monitoring for a few hours to a day.
• Pain management with prescribed medications.
• Instructions on wound care and activity restrictions.
• Typically, a follow-up appointment within 1-2 weeks to evaluate healing.
• Recovery time can range from a few days to weeks, depending on individual health status.

Alternatives

• Adjusting the settings of the neurostimulator
• Replacing or repositioning the electrodes instead of removal
• Pharmacologic pain management
• Other interventional pain management techniques like nerve blocks or ablations

Patient Experience

Patients can expect to feel discomfort or mild pain after the procedure, which should subside over time. Pain management and comfort measures, such as prescribed pain relievers and cold packs, are provided to alleviate discomfort. Follow-up care ensures proper healing and addresses any complications promptly.