Name of the Procedure:

• Common Name(s): Intraspinal catheter insertion
• Technical/Medical Term: Catheter, intraspinal (HCPCS Code: C1755)

Summary

The intraspinal catheter procedure involves inserting a thin, flexible tube into the intraspinal space to deliver medication directly to the spinal cord. This procedure is commonly used for the administration of pain medication or chemotherapy.

Purpose

• Medical Conditions/Problems Addressed: Chronic pain management, cancer pain, spasticity, administration of chemotherapeutic agents.
• Goals/Expected Outcomes: Effective pain control, reduced systemic side effects of medications, targeted delivery of chemotherapy to reduce tumor growth.

Indications

• Symptoms/Conditions Warranting the Procedure: Severe chronic pain unresponsive to oral medications, cancer-related pain, severe spasticity, localized tumors requiring direct chemotherapy.
• Criteria/Factors Making the Procedure Appropriate: Patients with chronic pain, inability to tolerate systemic medications, localized tumor growth requiring targeted treatment.

Preparation

• Pre-Procedure Instructions: Fasting for 6-8 hours before the procedure, medication adjustments as advised by the doctor.
• Diagnostic Tests/Assessments: Blood tests, MRI or CT scans to determine the exact area for catheter placement, pre-procedure clearance by an anesthesiologist.

Procedure Description

1. The patient is positioned in a way that allows access to the spine.
2. Local anesthesia or sedation is administered to minimize discomfort.
3. The skin is cleaned and a small incision is made in the area where the catheter will be inserted.
4. Using fluoroscopy (real-time X-ray), the catheter is inserted into the intraspinal space.
5. The catheter is then advanced to the desired location.
6. Once in place, the catheter is secured and attached to an external or implanted pump for medication delivery.
7. The incision is closed with sutures or surgical glue.

• Tools/Equipment: Intraspinal catheter, fluoroscopy machine, anesthesia equipment.
• Anesthesia Details: Local anesthesia with or without sedation.

Duration

Typically, the procedure takes about 1 to 2 hours.

Setting

Performed in a hospital operating room, interventional radiology suite, or an outpatient surgical center.

Personnel

• Surgeons or Interventional Radiologists
• Nurses
• Anesthesiologists

Risks and Complications

• Common Risks: Infection, bleeding, catheter displacement.
• Rare Risks: Cerebrospinal fluid leakage, nerve damage, adverse reaction to anesthesia.

Benefits

• Expected Benefits: Effective pain management, targeted drug delivery leading to fewer side effects, improved quality of life.
• Realization Time: Benefits can often be realized immediately or within a few days post-procedure.

Recovery

• Post-Procedure Care: Pain management, wound care, limited activity to allow for healing.
• Expected Recovery Time: Most patients recover within a few days to a week. Some restrictions on activity may apply.
• Follow-Up: Regular follow-up appointments to monitor catheter placement and efficacy of medication delivery.

Alternatives

• Other Treatment Options: Oral or intravenous medications, nerve blocks, physical therapy, surgical intervention.
• Pros and Cons: Alternatives may have more systemic side effects and may not be as effective in delivering medication directly to the source of pain or tumor.

Patient Experience

• During Procedure: Minimal discomfort due to anesthesia, with some potential pressure during catheter insertion.
• After Procedure: Possible mild pain or discomfort at the insertion site, managed with pain medications. Rest and limited activity are advised to promote healing.