Name of the Procedure:

Implantable Neurostimulator Pulse Generator (Single Array, Rechargeable), includes extension (HCPCS Code: L8685)

Summary

This procedure involves the implantation of a rechargeable neurostimulator pulse generator, a device used to deliver electrical pulses to specific nerves in the body. The device helps manage certain medical conditions by modulating nerve activity.

Purpose

The neurostimulator pulse generator is used to manage chronic pain and neurological conditions. The device aims to improve the patient's quality of life by reducing pain or controlling symptoms associated with specific neurological disorders.

Indications

The procedure is indicated for patients experiencing chronic, intractable pain that hasn't responded to other treatments, or for those with conditions like failed back surgery syndrome or complex regional pain syndrome. Criteria for the procedure include a thorough evaluation by a pain specialist and a successful trial of a temporary neurostimulation system.

Preparation

Patients might be instructed to fast for a few hours before the procedure and to adjust certain medications as advised by their healthcare provider. Pre-procedure evaluations may include imaging studies, blood tests, and a psychological assessment to ensure the patient is a suitable candidate.

Procedure Description

1. The patient is positioned, and the surgical site is cleaned and prepped.
2. Local anesthesia or general sedation is administered.
3. An incision is made to create a pocket where the neurostimulator will be placed.
4. The device is positioned under the skin, often near the abdomen or buttocks.
5. An extension wire is tunneled under the skin to connect the neurostimulator to the electrode array previously implanted near the spine.
6. The device is tested to ensure proper function.
7. The incisions are closed, and a dressing is applied.

Duration

The procedure typically takes about 1 to 2 hours.

Setting

The procedure is usually performed in a hospital or surgical center.

Personnel

The team typically includes a neurosurgeon or pain management specialist, an anesthesiologist, surgical nurses, and possibly a representative from the device manufacturer.

Risks and Complications

Common risks include infection, bleeding, and device malfunction. Rare complications might include nerve damage, allergic reactions to materials, or migration of the device or leads. Management involves prompt medical attention and, in some cases, additional surgery.

Benefits

Expected benefits include significant reduction in pain and improved functionality. Benefits might be realized within a few weeks post-procedure as the device settings are optimized.

Recovery

Patients will receive post-operative care instructions, which could include wound care, activity restrictions, and pain management. Recovery time may vary, but patients generally resume normal activities within a few weeks. Follow-up appointments are necessary to monitor device function and adjust settings.

Alternatives

Alternatives include medication management, physical therapy, other surgical interventions, or less invasive neurostimulation techniques. Each option has its own risks and benefits, which should be discussed with a healthcare provider.

Patient Experience

During the procedure, patients will be under local anesthesia or sedation, so they should feel minimal discomfort. Post-procedure, there may be some soreness at the incision site, which can be managed with pain medication. Over time, most patients experience significant pain relief or improvement in their condition.