64561 Percutaneous implantation of neurostimulator electrode array; sacral nerve (transforaminal placement) including image guidance, if performed

Name of the Procedure:

Percutaneous Implantation of Neurostimulator Electrode Array; Sacral Nerve (Transforaminal Placement)

• Common names: Sacral Nerve Stimulation, Sacral Neuromodulation
• Technical/medical terms: Percutaneous neurostimulator implantation, Transforaminal sacral nerve electrode placement

Summary

This minimally invasive procedure involves inserting a neurostimulator electrode array through the skin to stimulate the sacral nerves. The process uses image guidance to precisely position the electrodes, which help manage chronic pain or bladder/bowel control issues by sending electrical impulses to the sacral nerve.

Purpose

• To treat medical conditions related to chronic pelvic pain, urinary incontinence, fecal incontinence, and certain types of nerve pain.
• The goal is to alleviate symptoms, improve quality of life, and restore normal bladder/bowel function through targeted nerve stimulation.

Indications

• Chronic pelvic pain or sacral nerve pain.
• Overactive bladder symptoms or urinary incontinence unresponsive to other treatments.
• Fecal incontinence.
• Patients who have not responded adequately to conservative therapies such as medication and physical therapy.

Preparation

• Fasting for a specified period prior to the procedure.
• Adjustment or cessation of certain medications as directed by the physician.
• Pre-procedure diagnostic tests, such as imaging studies (MRI, CT scans) and a bladder diary, may be required.

Procedure Description

1. Anesthesia: The procedure typically begins with the administration of local anesthesia or moderate sedation.
2. Preparation: The patient is positioned carefully, and the skin is cleaned and sterilized.
3. Insertion: Using fluoroscopy or other imaging guidance, the physician inserts a needle through the skin and directs it to the sacral nerve via the foramen (openings in the pelvic bones).
4. Electrode Placement: The neurostimulator electrode array is then threaded through the needle and positioned adjacent to the sacral nerve.
5. Testing: The electrode array is tested to ensure proper placement and effective nerve stimulation.
6. Securing: Once the correct position is confirmed, the electrodes are secured, and the needle is removed.

Duration

The procedure typically lasts between 1 to 2 hours.

Setting

• Hospitals, outpatient surgical centers, or specialized neurology clinics.

Personnel

• Neurosurgeon or pain management specialist
• Nurses and radiology technicians
• Anesthesiologist (if sedation or general anesthesia is used)

Risks and Complications

• Common risks: Bleeding, infection, discomfort at the insertion site.
• Rare complications: Nerve damage, adverse reaction to anesthesia, movement of the electrode, and malfunction of the neurostimulator.

Benefits

• Improved control over bladder and bowel functions.
• Significant reduction in chronic pelvic pain.
• Enhanced overall quality of life.
• Benefits can typically be realized within a few weeks post-procedure.

Recovery

• Post-procedure care includes monitoring for signs of infection and maintaining the cleanliness of the insertion site.
• Patients can usually resume normal activities within a few days.
• Follow-up appointments to monitor the effectiveness and adjust the neurostimulator settings if needed.

Alternatives

• Medications (anticholinergics for bladder issues, pain management drugs)
• Behavioral therapies and pelvic floor exercises
• Intravesical botulinum toxin injections for bladder control
• Surgical interventions (e.g., bladder augmentation)
• Pros: Less invasive options available.
• Cons: May not be as effective for severe or treatment-resistant conditions, potential side effects.

Patient Experience

• During the procedure: Mild discomfort during needle insertion, managed through local anesthesia.
• After the procedure: Possible soreness at the insertion site, usually manageable with over-the-counter pain relief.
• Monitoring and periodic adjustments to the neurostimulator settings to ensure optimal outcomes.