Name of the Procedure:

Revision including replacement, when performed, of spinal neurostimulator electrode percutaneous array(s), including fluoroscopy, when performed.
Common Names: Spinal Neurostimulator Electrode Revision, Spinal Stimulator Electrode Adjustment

Summary

This procedure involves replacing or adjusting the electrodes of a spinal neurostimulator. It uses fluoroscopy (a type of X-ray) to ensure precise placement. This helps manage chronic pain when the initial electrode placement has become ineffective or problematic.

Purpose

The procedure addresses chronic pain conditions that haven't been adequately controlled by medications or only minimally invasive treatments. By adjusting or replacing electrodes, it aims to improve pain relief and restore the effectiveness of spinal neurostimulation.

Indications

• Inadequate pain relief from the current electrode placement
• Electrode migration or malfunction
• Changes in pain patterns
• Patient criteria: Persistent, severe, or disabling pain unrelieved by conservative treatments

Preparation

• Pre-procedure fasting (typically 6-8 hours)
• Adjusting medications as advised
• Pre-procedure tests: Blood tests, ECG, imaging studies (like MRI or X-rays)
• Informed consent discussion

Procedure Description

1. The patient is positioned and prepped with sterile technique.
2. Local anesthesia and light sedation are administered to minimize discomfort.
3. Using fluoroscopy, the surgeon guides a needle to the appropriate location along the spine.
4. The malfunctioning electrode array is removed or repositioned as necessary.
5. New electrodes are carefully placed if a replacement is needed.
6. Fluoroscopy confirms the proper electrode placement.
7. The incisions are closed and bandaged.

Duration

Typically 1 to 2 hours, depending on complexity.

Setting

The procedure is usually performed in a hospital or surgical center equipped with fluoroscopy.

Personnel

• Spine surgeon or pain management specialist
• Anesthesiologist
• Surgical nurse
• Radiology technician

Risks and Complications

• Infection
• Bleeding or hematoma
• Nerve damage
• Electrode dislodgement
• Allergic reaction to anesthesia
• Rare: Cerebrospinal fluid leak, hardware failure

Benefits

• Improved pain relief and quality of life
• Typically noticeable within days to weeks post-procedure

Recovery

• Post-procedure monitoring for a few hours
• Pain management with prescribed medications
• Limited activity for a few weeks
• Follow-up appointments for evaluation and device programming

Alternatives

• Conservative treatments: Physical therapy, medications, and lifestyle modifications
• Other interventional procedures: Nerve blocks, radiofrequency ablation
• Pros and cons: Alternatives may be less invasive but might not provide the same level of pain relief

Patient Experience

• Possible mild discomfort during the procedure.
• Post-procedure soreness at the incision site.
• Gradual improvement in pain management with proper device function.
• Ongoing adjustments might be needed for optimal results.