64565 Percutaneous implantation of neurostimulator electrode array; neuromuscular

Name of the Procedure:

Percutaneous Implantation of Neurostimulator Electrode Array; Neuromuscular

Summary

This procedure involves inserting a small device with electrodes to stimulate nerves and muscles. It's done through the skin, without major surgery, to help manage pain or improve muscle function.

Purpose

The main goal is to address chronic pain or muscle dysfunction when other treatments haven't worked. It aims to provide pain relief and improve the quality of life by electrically stimulating specific nerves or muscles.

Indications

• Chronic pain unresponsive to medications or other therapies
• Certain neuromuscular disorders
• Failed back surgery syndrome
• Complex regional pain syndrome (CRPS)
• Muscle rehabilitation post-injury or surgery

Preparation

• Fasting may be required for a few hours before the procedure.
• Medication adjustments, especially for blood thinners, might be necessary.
• Pre-procedure diagnostic tests such as imaging or nerve function tests.

Procedure Description

1. The patient is positioned comfortably, and local anesthesia or mild sedation is administered.
2. Using imaging guidance (like fluoroscopy or ultrasound), a needle is inserted through the skin to the target area.
3. Electrode(s) are placed via the needle, ensuring precise location near nerves or muscles.
4. Electrodes are connected to an external stimulator temporarily to ensure proper placement and effectiveness.
5. Once confirmed, electrodes are permanently fixed and connected to an implanted neurostimulator device.
6. The device settings are adjusted to optimize stimulation levels.

Duration

Typically takes 1-2 hours.

Setting

Performed in a hospital, outpatient clinic, or surgical center.

Personnel

• Pain management specialist or neurologist
• Nurses
• Anesthesiologist (if sedation is used)
• Radiologist (for imaging guidance)

Risks and Complications

• Common: Pain at the insertion site, infection, bleeding
• Rare: Nerve damage, allergic reaction to materials or anesthesia, equipment malfunction
• Management: Antibiotics for infection, pain management strategies, device adjustments

Benefits

• Effective pain relief
• Improved muscle function
• Enhanced mobility and quality of life Benefits can often be realized within days to weeks, depending on individual response.

Recovery

• Post-procedure monitoring for a few hours.
• Instructions on wound care and activity restrictions.
• Follow-up visits to adjust device settings and monitor progress.
• Most patients can resume normal activities within a few days, with some restrictions on heavy lifting or strenuous exercise.

Alternatives

• Medication management
• Physical therapy
• Surgical interventions (e.g., spinal cord stimulator implantation)
• Pros and cons of each alternative should be discussed with the healthcare provider; for instance, medications may have side effects, and more invasive surgeries carry higher risks.

Patient Experience

During the procedure, patients typically feel minimal pain due to local anesthesia. Afterward, some soreness or discomfort at the insertion site is common, managed with pain relievers. Comfort measures, rest, and gradual return to normal activities are advised.