Osteotomy of spine, including discectomy, anterior approach, single vertebral segment; each additional vertebral segment (List separately in addition to code for primary procedure)
CPT4 code
Name of the Procedure:
Osteotomy of the Spine, Including Discectomy, Anterior Approach, Single Vertebral Segment; Each Additional Vertebral Segment (List separately in addition to code for the primary procedure).
Summary
This surgical procedure involves cutting and reshaping a vertebral segment of the spine through the anterior (front) approach while also removing a damaged intervertebral disc. It primarily focuses on a single vertebral segment but can include additional segments as needed.
Purpose
Medical Condition Addressed:
- Spinal deformities (e.g., scoliosis, kyphosis).
- Degenerative disc disease.
Spinal stenosis.
Goals:
- Correct spinal alignment or deformity.
- Relieve nerve compression or pain.
- Restore function and mobility.
Indications
Symptoms/Conditions:
- Chronic back pain unresponsive to conservative treatments.
- Neurological deficits due to spinal compression.
- Severe spinal deformities causing functional or cosmetic concerns.
Patient Criteria:
- Patients with severe spinal deformities.
- Individuals with progressive neurological symptoms.
- Adults and sometimes adolescents depending on growth and development.
Preparation
Pre-Procedure Instructions:
- Fasting for at least 8 hours before surgery.
Adjustment or temporary discontinuation of certain medications (e.g., blood thinners).
Diagnostic Tests/Assessments:
- MRI or CT scans for precise spinal imaging.
- Blood tests and pre-anesthesia evaluations.
Procedure Description
- Anesthesia: General anesthesia is administered.
- Incision: A surgical incision is made in the front (anterior) of the spine.
- Discectomy: Removal of the damaged intervertebral disc.
- Osteotomy: Cutting and reshaping of the problematic vertebral segment(s).
- Stabilization: Insertion of hardware (e.g., screws, rods) to stabilize the spine.
- Closure: The incision is closed with sutures or staples.
Tools and Equipment:
- Surgical scalpels, retractors, bone saws.
- Imaging technology like fluoroscopy for guidance.
- Specialized spinal instrumentation for stabilization.
Duration
The procedure typically takes 3 to 6 hours, depending on the number of vertebral segments involved.
Setting
Typically performed in a hospital operating room with specialized equipment.
Personnel
- Orthopedic or Neurosurgeon.
- Surgical nurses.
- Anesthesiologist.
- Radiologic Technicians (if imaging is needed intra-operatively).
Risks and Complications
Common Risks:
- Infection.
- Blood loss.
Rare Risks:
- Spinal cord or nerve damage.
- Hardware failure or malposition.
- Non-union or improper healing of the bone.
Complication Management:
- Antibiotics for infections.
- Blood transfusion if necessary.
- Revision surgery for hardware issues.
Benefits
Expected Benefits:
- Alleviation of pain and discomfort.
- Improved spinal alignment and posture.
- Enhanced neurological function and mobility.
Timeline:
- Pain relief may be immediate, though full benefits are often seen within a few weeks to months.
Recovery
Post-Procedure Care:
- Pain management with medications.
- Physical therapy starting days or weeks after surgery.
Recovery Time:
- Initial recovery period of 4-6 weeks.
- Full recovery and return to normal activities may take up to 6 months.
Restrictions:
- Limited bending, lifting, and twisting.
- Follow-up appointments for progress monitoring and physical therapy.
Alternatives
Other Treatment Options:
- Non-surgical decompression.
Physical therapy and pain management.
Pros and Cons of Alternatives:
- Non-surgical options have fewer risks but may not be as effective for severe cases.
- Surgical options provide more definitive correction but come with higher risks and longer recovery time.
Patient Experience
During the Procedure:
- The patient will be under general anesthesia and unaware during the surgery.
After the Procedure:
- Expect soreness, pain, and restricted mobility in the immediate postoperative period.
- Pain management through medications, and comfort measures like appropriate bedding and supportive equipment.