Colleen Posted Mon 05th of November, 2018 13:04:20 PM
1. Removal of prior spinal cord stimulator paddle, wire and right flank power
2. Revision with new 16 plus paddle Penta lead at T8-9 and new power generator,
3. Physician-directed fluoroscopy.
4. Use of microscope.
Patient was placed prone on Jackson table with a Wilson frame with all bony prominences well padded. Patient’s back was prepped and draped in usual sterile fashion. After this, we used fluoroscopy to confirm the prior incisions were well positioned, and they were, and we injected 30 mL of Marcaine and epinephrine in the skin and subcutaneous, then used a 10-blade scalpel to reopen the prior incisions without incident. We dissected down, exposing the thoracic paddle and removing it without complication. There was some significant scar tissue about the paddle and this did require a complete T10 laminectomy to remove scar tissue and free a channel for the new paddle lead placed. After this was performed, the new paddle was positioned at the T8-9 with AP and lateral fluoroscopic imaging to verify its location. It was well positioned in midline.
This decompression, removal of scar tissue and placement of new paddle was
performed under microscope, high-powered magnification.
Following this, we reopen the flank power generator incision site and detached the prior wires from the battery and removed without difficulty. There was some serous fluid, but no sign of infection. We did thoroughly irrigate out both
thoracic and this right gluteal flank incision with bacitracin and saline prior to passing the new wires in the thoracic spine down into the right flank battery pouch. We then connected the new battery. We checked it for impedance with good connectivity throughout. We seated the battery in the pouch. We closed the deep fascial layers of the pouch as well as the thoracic fascia with 0 Vicryl followed by 2-0 Vicryl in the subcutaneous and 4-0 Monocryl running subcuticularly. Sterile Dermabond, Telfa, 4 x 4 and Elastofoam tape dressings
SuperCoder Answered Tue 06th of November, 2018 04:40:12 AM