22114 Partial excision of vertebral body, for intrinsic bony lesion, without decompression of spinal cord or nerve root(s), single vertebral segment; lumbar

Name of the Procedure:

Partial Excision of Vertebral Body for Intrinsic Bony Lesion, Without Decompression of Spinal Cord or Nerve Root(s), Single Vertebral Segment; Lumbar

Summary

This surgical procedure involves the partial removal of a vertebral body in the lower back (lumbar region) to treat a bone lesion. The procedure does not include decompression of the spinal cord or nerve roots.

Purpose

The procedure is performed to remove intrinsic bony lesions, which could be benign or malignant tumors or other abnormal growths within a single lumbar vertebral segment. The goal is to alleviate pain, prevent further growth, and restore spinal stability without affecting the spinal cord or nerve roots.

Indications

• Persistent lower back pain due to a bony lesion
• Evidence of a benign or malignant bone tumor
• Spinal instability caused by the lesion
• Diagnostic imaging confirming the location and size of the lesion

Preparation

• Fasting for a specified period before surgery
• Adjustments or discontinuation of certain medications, particularly blood thinners
• Pre-operative imaging studies such as MRI or CT scans
• Routine pre-surgical blood tests and physical examinations

Procedure Description

1. Anesthesia: General anesthesia is administered to ensure the patient is unconscious and pain-free.
2. Incision: A surgical incision is made in the lower back to access the affected vertebral segment.
3. Surgical Access: Muscles and tissues are carefully retracted to expose the vertebra.
4. Excision: Using specialized surgical tools, the surgeon partially excises the vertebral body containing the lesion.
5. Verification: Ensuring no decompression of the spinal cord or nerve roots occurs.
6. Closure: The incision is closed with sutures or staples, and a sterile dressing is applied.

Duration

The procedure typically takes 2 to 4 hours, depending on the complexity and size of the lesion.

Setting

The procedure is performed in a hospital operating room, usually with a short hospital stay for recovery.

Personnel

• Orthopedic or neurosurgeon
• Surgical nurses
• Anesthesiologist
• Radiologist (for intra-operative imaging if needed)

Risks and Complications

• Infection at the surgical site
• Bleeding or blood clots
• Damage to surrounding tissues or structures
• Incomplete removal of the lesion
• Spinal instability or need for additional surgeries

Benefits

• Relief from pain and discomfort caused by the lesion
• Prevention of lesion growth or further spinal damage
• Restored stability and function of the spine
• Improved quality of life

Recovery

• Initial recovery in a monitored hospital setting
• Gradual return to activities over 4 to 6 weeks
• Pain management with prescribed medications
• Physical therapy to regain strength and mobility
• Follow-up appointments to monitor healing and progress

Alternatives

• Observation and monitoring of the lesion
• Non-surgical treatments such as radiation therapy, depending on lesion type
• Complete excision and spinal fusion for more extensive lesions
• Each option has its own set of risks and benefits compared to partial excision

Patient Experience

During recovery, patients may experience discomfort and limited mobility. Pain is typically managed with medications, and most patients gradually regain normal activities with physical therapy and rest. Some soreness around the incision site is expected, but should decrease over time.