Name of the Procedure:

Implantable Neurostimulator, Pulse Generator, Any Type (HCPCS Code: L8679) Common names: Neurostimulator Implant, Neurostimulation Therapy, Spinal Cord Stimulator Implant

Summary

Neurostimulator implantation involves placing a device under the skin that sends electrical signals to specific nerves. It helps manage chronic pain by interfering with pain signals before they reach the brain.

Purpose

This procedure is designed to address chronic pain conditions that do not respond to traditional medical treatments. The goal is to reduce pain and improve the patient's quality of life by providing an alternative to opioid medications or invasive surgeries.

Indications

• Chronic pain in the back, neck, or limbs
• Conditions like failed back surgery syndrome, complex regional pain syndrome, and refractory angina
• Patients who have not benefited from conventional pain management therapies

Preparation

• Follow fasting instructions as directed by the healthcare provider
• Adjust or pause specific medications as advised, particularly blood thinners
• Complete pre-procedure diagnostic tests, such as MRI or CT scans, and a psychological evaluation to determine suitability

Procedure Description

1. Anesthesia: The patient receives local anesthesia and sedation, or general anesthesia.
2. Incision: Small incisions are made in the skin where the device and leads will be implanted.
3. Lead Placement: Electrodes (leads) are placed near the spinal cord or target nerve.
4. Testing: The device is temporarily connected and tested to ensure pain relief.
5. Implantation: The pulse generator is implanted under the skin, usually in the abdomen or upper buttocks.
6. Connection: The leads are connected to the pulse generator.
7. Closure: Incisions are closed with sutures or staples.

Duration

The procedure typically takes 1 to 2 hours.

Setting

The procedure is performed in a hospital operating room or an outpatient surgical center.

Personnel

• Surgeon (usually a neurosurgeon or pain management specialist)
• Anesthesiologist
• Surgical nurses
• Technician to assist with the programming of the device

Risks and Complications

• Infection at the incision site
• Bleeding or hematoma formation
• Nerve damage or neurological deficits
• Device malfunction or migration
• Allergic reaction to materials
• Pain at the implant site
• Rare but serious complications include hardware failure and undesirable changes in stimulation

Benefits

• Significant reduction in chronic pain
• Decreased dependence on pain medications
• Improved functionality and quality of life
• Pain relief can often begin immediately but may take a few weeks for optimal adjustment

Recovery

• Follow detailed post-operative care instructions, including site care and activity restrictions
• Pain management plan including prescribed medications
• Attend follow-up appointments for wound checks and device programming
• Full recovery and adaptation period may take several weeks to months

Alternatives

• Conservative treatments: Physical therapy, medications, and nerve blocks
• Surgical interventions: Spinal surgeries or decompressive procedures
• Pros: Less invasive options may avoid surgery
• Cons: Alternative treatments may take longer to show results or be less effective for severe pain

Patient Experience

During the procedure, you might feel a small amount of pressure but should not experience pain due to anesthesia. Post-procedure, expect some swelling and discomfort at the incision sites, manageable with prescribed painkillers. Regular follow-up visits are necessary for device adjustments and to monitor recovery progress.