Percutaneous vertebral augmentation, including cavity creation (fracture reduction and bone biopsy included when performed) using mechanical device (eg, kyphoplasty), 1 vertebral body, unilateral or bilateral cannulation, inclusive of all imaging guidance
CPT4 code
Name of the Procedure:
Percutaneous Vertebral Augmentation using Mechanical Device (e.g., Kyphoplasty), including Cavity Creation, Fracture Reduction, and Bone Biopsy if performed.
Summary
This minimally invasive procedure involves the repair of a fractured vertebra by inserting a balloon-like device to create a cavity, followed by filling the cavity with bone cement. Imaging guidance is used to ensure precision. The procedure can be performed on one vertebra and can use unilateral or bilateral cannulation.
Purpose
It aims to treat vertebral compression fractures, reduce pain, restore vertebral height, and stabilize the fractured bone. It may also involve taking a biopsy of the bone if needed.
Indications
- Severe back pain due to vertebral compression fractures
- Osteoporosis-related fractures
- Traumatic vertebral fractures
- Neoplastic lesions causing vertebral fractures
Preparation
- Fasting for a few hours before the procedure
- Adjustments to medications, particularly blood thinners
- Pre-procedure imaging such as MRI or CT scans to assess the fracture
Procedure Description
- Anesthesia: Local anesthesia with sedation or general anesthesia.
- Imaging Guidance: Continuous fluoroscopy or CT for precise navigation.
- Cannulation: A small incision is made, and a needle is inserted into the fractured vertebra.
- Cavity Creation: A balloon-like device is inserted and inflated to create a cavity and restore vertebral height.
- Fracture Reduction: The inflation helps to correct the deformity caused by the fracture.
- Bone Biopsy: If needed, a sample of the bone is taken.
- Cement Injection: Bone cement is injected into the cavity to stabilize the vertebra.
- Final Imaging: Ensures proper placement of cement and no complications.
Duration
Typically takes 1-2 hours.
Setting
Usually performed in a hospital or outpatient surgical center.
Personnel
- Interventional radiologists or orthopedic spine surgeons perform the procedure.
- Nursing staff and anesthesiologists assist.
Risks and Complications
- Infection
- Bleeding or hematoma
- Cement leakage
- Nerve damage
- Pulmonary embolism (very rare)
Benefits
- Immediate pain relief in many cases
- Improved mobility and reduced pain medication dependence
- Restoration of vertebral height and spinal alignment
Recovery
- Short recovery period; often same-day or next-day discharge
- Avoid heavy lifting and strenuous activities for a few weeks
- Follow-up imaging and appointments to monitor healing
Alternatives
- Conservative treatment like bed rest, pain medications, and physical therapy
- Vertebroplasty (another form of vertebral augmentation)
- Surgical intervention for severe cases
Patient Experience
The patient may feel mild discomfort during the procedure due to anesthesia administration. Post-procedure, some pain and soreness are common but manageable with pain medications. Most patients experience significant pain relief within hours to days.