63664 Revision including replacement, when performed, of spinal neurostimulator electrode plate/paddle(s) placed via laminotomy or laminectomy, including fluoroscopy, when performed

Name of the Procedure:

Revision including replacement, when performed, of spinal neurostimulator electrode plate/paddle(s) placed via laminotomy or laminectomy, including fluoroscopy, when performed.

Summary

This procedure involves revising and potentially replacing the electrode plate or paddle of a spinal neurostimulator. A spinal neurostimulator is a device used to manage chronic pain by sending electrical impulses to the spinal cord. The revision is performed through surgical techniques known as laminotomy or laminectomy, often with the use of fluoroscopic guidance to ensure precise placement.

Purpose

The procedure addresses issues such as malfunctioning or improperly positioned electrodes in a spinal neurostimulator system. The goal is to alleviate chronic pain by ensuring the neurostimulator works effectively.

Indications

• Persistent or unrelieved chronic pain despite initial neurostimulator placement.
• Malfunctioning electrode plate/paddle.
• Patient experiences side effects or complications from initial placement.
• Device migration or improper electrode placement detected.
• Hardware damage or wear over time.

Preparation

• Fasting may be required from midnight before the procedure.
• Adjustments in medications, particularly blood thinners, based on physician's recommendations.
• Preoperative imaging studies such as MRI or CT scans.
• Routine blood tests and medical evaluations to assess overall health.

Procedure Description

1. The patient is sedated or given general anesthesia.
2. A small incision is made at the site of the original implant.
3. A laminotomy or laminectomy is performed to access the spinal column.
4. The existing electrode plate/paddle is located and evaluated.
5. If necessary, the electrode is replaced with a new one.
6. Placement of the electrode is confirmed using fluoroscopy.
7. The incision is closed and dressed.

Duration

The procedure typically takes between 2 to 4 hours, depending on complexity.

Setting

The procedure is performed in a hospital or surgical center with the necessary sterile facilities and imaging equipment.

Personnel

• Neurosurgeon or orthopedic surgeon specializing in spinal surgery.
• Anesthesiologist or nurse anesthetist.
• Surgical nurses and technologists.
• Radiologic technologist for fluoroscopy.

Risks and Complications

• Infection
• Bleeding
• Nerve damage
• Device malfunction or migration
• Pain at the surgical site
• Anesthesia-related risks
• Rarely, spinal cord injury

Benefits

• Improved pain management and reduction in chronic pain symptoms.
• Enhanced quality of life.
• Potentially reduced need for pain medication over time.

Recovery

• Initial recovery in the post-anesthesia care unit (PACU).
• Hospital stay of 1 to 2 days, typically.
• Limited activity for several weeks; avoid heavy lifting and strenuous activities.
• Follow-up appointments to monitor recovery and device function.
• Pain management with prescribed medications as needed.

Alternatives

• Conservative management with pain medications and physical therapy.
• Reprogramming of the existing neurostimulator device.
• Alternative forms of neuromodulation or nerve blocks.
• Surgical options such as spinal fusion or other pain management surgeries.

Patient Experience

• Under anesthesia, the patient will not feel pain during the procedure.
• Post-operative pain at the incision site managed with pain medication.
• Initial discomfort and restrictions in activity during the first few weeks.
• Gradual return to normal activities with improvement in pain management over time.