Name of the Procedure:

Removal of Spinal Neurostimulator Electrode Plate/Paddle(s) via Laminotomy or Laminectomy, including Fluoroscopy

Summary

This procedure involves the removal of a specialized medical device, called a neurostimulator electrode plate or paddle, that was previously placed in the spine to manage pain. The removal is done using a surgical approach to the spine called laminotomy or laminectomy and often involves the use of X-ray guidance (fluoroscopy).

Purpose

This procedure addresses complications, malfunctions, or inadequate pain relief from previously implanted spinal neurostimulator electrodes. The goal is to safely remove the device to alleviate symptoms such as chronic pain or to replace a faulty system.

Indications

• Persistent pain despite the spinal neurostimulator
• Infection at the implant site
• Malfunction or displacement of the electrode
• Need to upgrade or replace the device
• Patient's decision to discontinue neurostimulation therapy

Preparation

• Fasting for at least 6-8 hours before the procedure
• Adjustment or temporary cessation of certain medications as directed by the physician
• Pre-procedure imaging studies (MRI, CT scan, or X-rays) to evaluate the placement
• Blood tests to ensure normal clotting and absence of infection

Procedure Description

1. The patient is given anesthesia to ensure they are comfortable and pain-free.
2. An incision is made at the site of the previous implant.
3. A laminotomy or laminectomy is performed to access the electrode plate/paddle.
4. Fluoroscopy is often used to visualize the exact position of the electrode.
5. The electrode plate/paddle is carefully detached and removed.
6. The incision is closed with sutures or staples.

Tools and equipment include surgical instruments, the neurostimulator-specific removal kit, and fluoroscopy equipment for real-time imaging.

Duration

Approximately 1 to 3 hours, depending on the complexity of the case.

Setting

Hospital operating room or a surgical center.

Personnel

• Orthopedic or neurosurgeon
• Anesthesiologist
• Surgical nurses
• Radiology technician (for fluoroscopy)

Risks and Complications

• Infection
• Bleeding
• Nerve injury
• Spinal fluid leak
• Failure to fully relieve symptoms
• Chronic pain or discomfort at the surgery site

Benefits

• Alleviation of complications related to the neurostimulator
• Relief from device-related discomfort or malfunction
• Potential improvement in pain management with a new or alternative therapy

Recovery

• Initial recovery in a post-anesthesia care unit
• Pain management with medications
• Instructions on wound care and activity restrictions
• Follow-up appointments to monitor healing and discuss further pain management options
• Most patients can resume normal activities within a few weeks, but heavy lifting and strenuous activities should be avoided initially

Alternatives

• Revision or replacement of the neurostimulator
• Medication adjustments
• Physical therapy
• Alternative pain management interventions such as nerve blocks or different neuromodulation therapies

Each alternative has its own pros and cons, which should be discussed with the healthcare provider.

Patient Experience

Patients may feel some discomfort during the recovery phase, which is typically managed with pain medications. The surgical site may be sore, and activity levels will be temporarily reduced to facilitate healing. Most patients report gradual improvement in their symptoms and well-being post-procedure.