Name of the Procedure:

Common name: Implantable Neurostimulator with Rechargeable Battery
Technical term: Generator, Neurostimulator (Implantable), with Rechargeable Battery and Charging System (HCPCS Code: C1820)

Summary

In this procedure, a small device called a neurostimulator is surgically implanted under the skin to help manage chronic pain. The neurostimulator delivers electrical impulses to specific nerves which helps in modulating pain signals before they reach the brain. The implanted device includes a rechargeable battery and a charging system that allows the patient to charge the device externally.

Purpose

Medical Conditions Addressed:

• Chronic pain conditions
• Neuropathic pain
• Certain cases of failed back surgery syndrome
• Complex regional pain syndrome

Goals:

• Alleviate chronic pain
• Improve overall quality of life
• Reduce dependency on pain medications

Indications

Appropriate for Patients Who:

• Suffer from severe chronic pain that doesn’t respond to conservative treatments
• Have undergone and failed other pain management therapies
• Are healthy enough for minor to moderate surgical procedures
• Are willing to adhere to follow-up and charging regimens

Preparation

• Follow fasting instructions provided by your healthcare provider
• Adjust or discontinue certain medications as advised by your physician
• Complete any required diagnostic tests such as MRI or CT scans
• Arrange for a responsible adult to accompany you and drive you home post-procedure

Procedure Description

1. Anesthesia: The patient will receive general or local anesthesia.
2. Incision: A small incision is made, usually in the lower back or abdomen.
3. Lead Placement: Electrodes (leads) are placed near the spinal cord or targeted nerves.
4. Neurostimulator Placement: The neurostimulator device is implanted under the skin.
5. Connection: Leads are connected to the neurostimulator.
6. Programming: The device is programmed to deliver appropriate electrical impulses.
7. Closure: The incision is closed with sutures or surgical glue.

Tools/Equipment:

• Neurostimulator device with rechargeable battery
• Leads or electrodes
• Surgical instruments

Anesthesia:

• Local or general anesthesia, based on the specific case

Duration

• The procedure typically takes 1 to 2 hours.

Setting

• Usually performed in a hospital or an outpatient surgical center.

Personnel

• Surgeon (typically a neurosurgeon or pain management specialist)
• Anesthesiologist
• Operating room nurses
• Technicians for device programming

Risks and Complications

Common Risks:

• Infection at the implant site
• Pain at the incision site
• Hardware malfunction

Rare Risks:

• Nerve damage
• Allergic reactions to the implanted device
• Lead migration or breakage

Management:

• Antibiotics for infections
• Surgical revision for hardware issues

Benefits

• Significant reduction in chronic pain
• Decreased need for pain medications
• Improved daily functioning and quality of life
• Benefits can often be realized within weeks following the procedure

Recovery

• Light activity can usually be resumed a few days post-procedure
• Full recovery might take several weeks
• Follow standard wound care instructions provided by your healthcare professional
• Attend scheduled follow-up appointments for device adjustments and monitoring

Alternatives

Other Options:

• Oral medications (e.g., opioids, NSAIDs)
• Physical therapy
• Nerve blocks
• Radiofrequency ablation

Comparison:

• Medications: Potential for dependence and side effects, but non-invasive.
• Physical therapy: Beneficial but may not be sufficient alone.
• Nerve blocks: Short-term relief.
• Radiofrequency ablation: Non-surgical but temporary.

Patient Experience

During Procedure:

• Under anesthesia, the patient won't feel pain but may experience mild discomfort from the incisions afterward.

After Procedure:

• Mild pain or discomfort at the incision site
• Sense of tingling or light impulses as the device starts functioning
• Pain management prescribed as needed

Comfort Measures:

• Pain medications
• Ice packs on the incision site
• Follow the healthcare provider’s instructions carefully

By understanding the procedure, purpose, and necessary preparations, patients can make informed decisions and feel more comfortable with their treatment plan.