Name of the Procedure:

Generator, Neurostimulator (Implantable), Non-rechargeable (HCPCS code: C1767)

Common Names: Neurostimulator implant, Spinal cord stimulator

Technical/Medical Terms: Implantable neurostimulator generator, Neurostimulation device

Summary

In simple terms, this procedure involves implanting a small device under the skin that helps manage chronic pain by sending electrical signals to the spine.

Purpose

This procedure is used to relieve chronic pain conditions that have not responded well to other treatments. The goal is to improve the patient's quality of life by reducing pain and decreasing the need for pain medications.

Indications

• Chronic pain in the back, arms, or legs
• Failed back surgery syndrome (persistent pain after back surgery)
• Complex regional pain syndrome (CRPS)
• Peripheral neuropathy
• Patients who have not found relief from conservative therapies such as medications, physical therapy, or nerve blocks

Preparation

• Patients may need to fast for a certain period before the procedure.
• Medications may need to be adjusted, especially blood thinners.
• Pre-procedure assessments can include imaging tests like MRI or CT scans and a psychological evaluation to ensure suitability for the implant.

Procedure Description

1. The patient is given local anesthesia and sedatives.
2. A small incision is made in the back, and an insulated wire (lead) is placed near the spinal cord.
3. The lead is connected to the neurostimulator generator, which is implanted under the skin (usually in the buttock, abdomen, or chest).
4. The device is tested to ensure proper placement and functionality.
5. Incisions are closed and bandaged.

Tools and Equipment: Leads, neurostimulator generator, fluoroscope (for imaging)

Anesthesia: Local anesthesia with sedation or general anesthesia, depending on the patient's condition.

Duration

The procedure typically takes 1-2 hours.

Setting

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

Personnel

• A surgeon, typically a neurosurgeon or a pain management specialist
• Nurses and surgical technicians
• An anesthesiologist or nurse anesthetist

Risks and Complications

• Infection at the implant site
• Bleeding or swelling
• Lead movement or breakage
• Device malfunction
• Spinal fluid leak
• Allergic reactions to materials used

Benefits

• Significant pain reduction
• Improved ability to perform daily activities
• Decreased reliance on pain medications
• Enhanced quality of life

Patients might begin to notice pain relief soon after the device is activated, which can be adjusted during follow-up visits.

Recovery

• Post-procedure care includes wound care, activity restrictions, and pain management.
• Expect some soreness at the incision sites.
• Most patients can resume normal activities within a few weeks, but strenuous activities should be avoided for about 6-8 weeks.
• Follow-up appointments are necessary to monitor the device and make adjustments.

Alternatives

• Pain medications
• Physical therapy
• Nerve blocks or epidural injections
• Non-implantable external neurostimulators

Pros: Non-invasive options might be less risky initially.

Cons: Conservative treatments may not provide sustained relief and could have side effects.

Patient Experience

During the procedure, the patient might feel some discomfort due to local anesthesia but should not feel pain. Afterward, there is typically some soreness and discomfort at the incision sites. Pain relief from the stimulator can vary initially, and adjustments may be necessary to optimize its effectiveness.

Pain Management: Pain medications can be prescribed for post-operative discomfort. Most patients describe the stimulation as a tingling sensation rather than pain.