64585 Revision or removal of peripheral neurostimulator electrode array

Name of the Procedure:

Revision or Removal of Peripheral Neurostimulator Electrode Array

Summary

This procedure involves either adjusting or completely removing an electrode array that is part of a peripheral neurostimulator system. These devices are used to manage pain by delivering electrical impulses to specific nerves.

Purpose

The primary purpose of this procedure is to address issues with the current neurostimulator system, such as inefficacy, discomfort, or complications. The goal is to alleviate pain or resolve problems related to the initial implant.

Indications

• Inadequate pain relief from the current neurostimulator
• Discomfort or pain at the electrode site
• Infection or inflammation around the implant area
• Device malfunction or hardware issues
• Patient request for device removal

Preparation

• Fasting for 6-8 hours prior to the procedure if anesthesia is used
• Medication adjustments as advised by the healthcare provider
• Pre-procedure diagnostic tests, such as imaging studies, to locate the electrode array

Procedure Description

1. Preparation: The patient is positioned, and the procedure site is sterilized.
2. Anesthesia: Local or general anesthesia is administered.
3. Incision: An incision is made over the implant site.
4. Revision or Removal: The electrode array is either adjusted or completely removed. If a revision is needed, new positioning or additional hardware might be placed.
5. Closure: The incision is closed with sutures or surgical staples.
6. Finalization: Post-procedure dressing is applied.

Tools and equipment include surgical instruments, imaging devices for accurate placement, and monitoring equipment.

Duration

The procedure typically lasts between 1-2 hours.

Setting

This procedure is usually performed in a hospital or an outpatient surgical center.

Personnel

• Surgeon
• Nurses
• Anesthesiologist (if general anesthesia is used)
• Surgical technician

Risks and Complications

• Infection
• Bleeding
• Nerve damage
• Anesthesia-related risks
• Pain at the surgical site
• Incomplete pain relief or return of symptoms

Benefits

• Improved pain management
• Resolution of complications associated with the previous implant
• Enhanced comfort
• Increased quality of life

Recovery

• Pain management with prescribed medications.
• Keeping the incision site clean and dry.
• Follow-up appointments to monitor healing.
• Avoiding strenuous activities for several weeks.
• Gradual return to normal activities as advised by the healthcare provider.

Alternatives

• Adjusting the settings on the current neurostimulator
• Trying different pain management strategies (medications, physical therapy)
• Alternative surgical interventions
• Pros and cons should be discussed with a healthcare provider to determine the best approach.

Patient Experience

During the procedure, the patient should not feel pain due to anesthesia. Post-procedure, there may be discomfort at the incision site, which can be managed with pain medication. Patients may experience an improved quality of life as pain is managed more effectively after recovery.