22101 Partial excision of posterior vertebral component (eg, spinous process, lamina or facet) for intrinsic bony lesion, single vertebral segment; thoracic

Name of the Procedure:

Partial Excision of Posterior Vertebral Component (e.g., Spinous Process, Lamina, or Facet) for Intrinsic Bony Lesion, Single Vertebral Segment; Thoracic

Summary

This surgical procedure involves removing a part of the vertebra in the thoracic spine to treat a bony lesion. The excision may involve the spinous process, lamina, or facet of a single vertebral segment.

Purpose

This procedure addresses bony lesions (e.g., benign tumors or bone growths) that could cause pain, neurological deficits, or structural deformities in the thoracic spine. The goal is to relieve symptoms, prevent further spinal damage, and improve the patient's quality of life.

Indications

• Persistent back pain localized to the thoracic spine
• Neurological symptoms such as numbness, weakness, or tingling in extremities
• Radiological evidence of bony lesions on imaging studies (e.g., X-rays, MRI, CT scans)
• Failure to respond to conservative treatments (e.g., medications, physical therapy)

Preparation

• Patients may need to fast for several hours before the procedure.
• Medication adjustments, particularly blood thinners, may be required.
• Preoperative imaging studies (e.g., MRI or CT scan) to evaluate the lesion and plan the surgery.
• Preoperative blood tests and physical examination.

Procedure Description

1. The patient is typically placed under general anesthesia.
2. A small incision is made over the affected area of the thoracic spine.
3. Through this incision, the affected spinous process, lamina, or facet is partially removed using specialized surgical instruments.
4. The surgeon focuses on excising the bony lesion while preserving as much of the healthy bone and surrounding tissues as possible.
5. Hemostasis is achieved, and the incision is closed with sutures or surgical staples.
6. A dressing is applied to the surgical site.

Duration

The procedure typically takes about 1 to 3 hours, depending on the complexity and location of the lesion.

Setting

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

Personnel

• Orthopedic or neurosurgeon
• Anesthesiologist
• Surgical nurses
• Surgical technologist

Risks and Complications

• Infection at the surgical site
• Excessive bleeding
• Damage to surrounding nerves or spinal cord
• Spinal instability
• Anesthesia-related risks

Benefits

• Relief from pain caused by the bony lesion
• Improvement in neurological symptoms
• Prevention of further spinal damage
• Enhanced quality of life

Recovery

• Patients may need to stay in the hospital for 1-2 days following the procedure.
• Pain management, including medications, will be provided.
• Patients are usually advised to avoid heavy lifting and intense physical activity for several weeks.
• Follow-up appointments for wound care and to monitor recovery progress.

Alternatives

• Conservative management (e.g., pain relief medication, physical therapy)
• Stereotactic radiosurgery or radiation therapy for specific lesions
• Other surgical options, such as a complete laminectomy or spinal fusion, depending on the severity and location of the lesion
• Pros and cons will vary based on the individual patient's condition and overall health.

Patient Experience

Patients can expect some discomfort and pain at the surgical site, which can be managed with medications. Swelling and bruising are also common. Most patients will notice an improvement in their symptoms within a few weeks, though full recovery can take several months. It's crucial to adhere to post-operative instructions to ensure a smooth recovery.