Permanent implantation of neuromodulation ...
There are two pathways to having an implanted neuromodulation unit. Either you have previously completed a successful trial of neuromodulation, or as a result of positive diagnostic nerve blocks a neuromodulation unit has been recommended.
What is the procedure?
If you have previously had a successful trial of neuromodulation, the doctor will reinsert the leads in the same place, secure the leads to the subcutaneous tissues and then tunnel the leads under the skin to the battery site where he will create a subcutaneous pocket for the battery. The site of battery placement will be discussed with you prior to your procedure.
You will either be sedated or given a general anaesthetic for the procedure. The type of anaesthetic depends on whether the doctor needs to test lead placement intra-operatively (usual for epidural leads) or not. If on-table testing is required, you will be awakened during the procedure to allow this to occur.
If you have previously had positive nerve blocks and the diagnosis has been positively confirmed the neuromodulation unit will implanted under general anaesthesia.
What is involved in the procedure?
You will be admitted to hospital and the nurses will prepare you for theatre. The anaesthetist will consult with you prior to your surgery, and in theatre will place an intravenous cannula and monitors for your heart and lungs. You will then be either heavily sedated or given a general anaesthetic before the neuromodulation leads are inserted under x-ray guidance.
If you are undergoing epidural lead placement for dorsal column stimulation, you may be woken up and the representative from the device company will turn on the stimulator once the doctor has inserted the leads to check that the leads are positioned correctly.
The battery will be placed under the skin in a location decided previously by Dr Cornish in consultation with you. The leads will be connected under the skin to the battery,
After the surgery is complete, you will be woken up and transferred to the recovery room for 1-2 hours. You will then be transferred to the ward. You will stay in hospital overnight, and the representative from the device company or the practice nurse will see you and program the neuromodulation unit. A physiotherapist will also visit you before discharge and give you a range of gentle exercises for the weeks after surgery. The physiotherapist will also be fit you with a brace or collar depending on the site of your surgery, to protect the leads.
You will return to our office to see your doctor 4 days after the procedure for a wound check and reprogramming and then 10 days after the procedure to have the sutures removed and a programming check.
What are the possible complications?
This procedure has a very low risk of complications, but there are some that you should be aware of:
Local discomfort: patients are likely to experience some discomfort in the area of the surgery for a few days. This is usually managed with oral analgesics.
Lead migration: Sometimes the leads can move and the pain relief you get from the stimulation will lessen. Sometimes this can be fixed by having the representative from the device company reprogram your stimulator. In other cases, you may need to go back to theatre for revision surgery.
Post-dural puncture headache: this applies to leads placed in the epidural space. Occasionally patients may develop a headache which is worse when the patient is standing up. This type of headache is very uncommon, but can happen if the needle pierces the dura (inside membrane of the epidural space). Please contact our office if you develop a headache after the procedure.
Bleeding or infection:
If you have had peripheral leads placed, please contact our office immediately if you feel feverish, develop redness, pain or have discharge around your wounds.
If you have had epidural leads inserted - please contact our office immediately if you feel feverish, develop back pain, a headache or weakness in the legs. If these symptoms occur outside of office hours, you should attend the nearest emergency department.