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Percutaneous implantation of neurostimulator electrode array; sacral nerve (transforaminal placement) including image guidance, if performed
CPT4 code
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
- Anesthesia: The procedure typically begins with the administration of local anesthesia or moderate sedation.
- Preparation: The patient is positioned carefully, and the skin is cleaned and sterilized.
- 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).
- Electrode Placement: The neurostimulator electrode array is then threaded through the needle and positioned adjacent to the sacral nerve.
- Testing: The electrode array is tested to ensure proper placement and effective nerve stimulation.
- 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.