Name of the Procedure:

Insertion or Replacement of Spinal Neurostimulator Pulse Generator or Receiver, Direct or Inductive Coupling. Common names: Spinal Neurostimulator Implant, SCS (Spinal Cord Stimulation) Pulse Generator Implant.

Summary

This procedure involves surgically placing a small device called a pulse generator or receiver near the spine. The device sends electrical signals to the spinal cord to alleviate chronic pain.

Purpose

The medical condition or problem it addresses:

• Chronic pain in the back, legs, or arms not relieved by other treatments.

The goals or expected outcomes of the procedure:

• To reduce pain and improve the quality of life for patients with chronic pain.
• To decrease dependency on pain medications.

Indications

Specific symptoms or conditions that warrant the procedure:

• Persistent, severe pain that has not responded to conservative treatments like medication, physical therapy, or injections.

Patient criteria or factors that make the procedure appropriate:

• Patients with a confirmed diagnosis of chronic pain.
• Patients who have responded positively to a trial stimulation.

Preparation

Pre-procedure instructions for the patient:

• You may be asked to fast for several hours before surgery.
• Medications may need to be adjusted, specifically anticoagulants and antiplatelets.

Any diagnostic tests or assessments required beforehand:

• MRI or CT scans to visualize the spine.
• Psychological evaluation to ensure suitability for the implant.

Procedure Description

Detailed step-by-step explanation:

1. The patient is positioned on the operating table, and the surgical site is sterilized.
2. An incision is made near the spine.
3. Leads (wires) connected to the pulse generator are placed near specific nerves.
4. The pulse generator is implanted under the skin, typically in the lower back or abdomen.
5. The incision is closed with sutures.

Tools, equipment, or technology used:

• Pulse generator, leads, surgical instruments, fluoroscopy (for imaging guidance).

Anesthesia or sedation details:

• General anesthesia or local anesthesia with sedation.

Duration

How long the procedure typically takes:

• Approximately 1 to 2 hours.

Setting

Where the procedure is performed:

• Hospital or outpatient surgical center.

Personnel

Healthcare professionals involved:

• Surgeons, anesthesiologists, surgical nurses, and possibly pain management specialists.

Risks and Complications

Common and rare risks associated with the procedure:

• Infection, bleeding, nerve damage, hardware malfunction, and cerebrospinal fluid leak.

Possible complications and their management:

• Device infection requiring removal, lead migration necessitating repositioning, reprogramming of the device for optimal pain relief.

Benefits

Expected benefits and how soon they might be realized:

• Significant pain reduction often noticeable within a few days to weeks.
• Improved functionality and quality of life.
• Potential reduction in the use of pain medications.

Recovery

Post-procedure care and instructions:

• Keep the incision clean and dry.
• Avoid strenuous activities and heavy lifting for several weeks.
• Follow-up appointments to monitor healing and device function.

Expected recovery time and any restrictions:

• Recovery time ranges from a few days to a few weeks.
• Activity restrictions generally last 4 to 6 weeks.

Alternatives

Other treatment options available:

• Pain medications, physical therapy, nerve blocks, or radiofrequency ablation.

Pros and cons of alternatives:

• Medications may have systemic side effects; physical therapy might be less effective for severe pain.
• Neurostimulator implantation offers a targeted and drug-free pain relief solution.

Patient Experience

What the patient might feel or experience during and after the procedure:

• Mild discomfort or pain at the incision site.
• Possible tingling sensations as the device settings are adjusted.
• Pain relief might be immediate but can take a few weeks for full effect.

Pain management and comfort measures:

• Pain medications and anti-inflammatory drugs as needed.
• Follow-up visits for device programming adjustments and pain assessment.