22548 Arthrodesis, anterior transoral or extraoral technique, clivus-C1-C2 (atlas-axis), with or without excision of odontoid process

Name of the Procedure:

Arthrodesis, Anterior Transoral or Extraoral Technique, Clivus-C1-C2 (Atlas-Axis), with or without Excision of Odontoid Process

Summary

In layman's terms, this is a surgical procedure that involves fusing certain bones in the neck (the upper cervical vertebrae) through an approach from the front of the neck. Sometimes, part of one of these bones (called the odontoid process) is removed during the procedure.

Purpose

This procedure is intended to stabilize the upper part of the spine. It is typically used to treat instability in this area, which can be caused by conditions like fractures, arthritis, infections, or tumors. The main goal is to relieve pain, improve stability, and protect the spinal cord from further injury.

Indications

Arthrodesis in this area is recommended for patients experiencing:

• Severe neck pain due to instability
• Neurological symptoms like weakness or numbness due to spinal cord compression
• Conditions like rheumatoid arthritis, trauma, or congenital anomalies affecting the cervical spine
• Failure of conservative treatments such as physical therapy or medications

Preparation

Patients are usually instructed to:

• Fast for 8-12 hours before the procedure
• Adjust or stop certain medications, such as blood thinners, as directed by the doctor
• Undergo preoperative imaging tests like an MRI or CT scan to map the surgical area

Procedure Description

The procedure involves the following steps:

1. The patient is placed under general anesthesia.
2. An incision is made either through the mouth (transoral) or on the neck (extraoral).
3. Surgical instruments are used to access the upper cervical spine.
4. The surgeon removes part or all of the odontoid process if necessary.
5. Bone graft material and/or metal hardware is used to fuse the clivus-C1-C2 vertebrae together.
6. The incision is closed with sutures or staples.

Duration

The entire procedure typically takes between 3 to 6 hours, depending on its complexity.

Setting

This surgery is performed in a hospital setting, specifically in a sterile operating room equipped for spinal surgeries.

Personnel

The procedure involves:

• An orthopedic or neurosurgeon specialized in spinal surgeries
• An anesthesiologist
• Surgical nurses and technicians
• Possible assistance from radiologists for intraoperative imaging

Risks and Complications

Potential risks include:

• Infection
• Bleeding or hematoma
• Nerve damage or spinal cord injury
• Hardware failure or dislodgement
• Nonunion (failure of the bones to fuse)

Benefits

The primary benefits are reduced pain, improved neck stability, and prevention of further neurological decline. Most patients begin to notice these improvements within a few weeks to months after surgery.

Recovery

Post-procedure care includes:

• Hospital stay of 3-5 days
• Use of a neck brace or collar for several weeks
• Pain management with prescribed medications
• Physical therapy to regain strength and mobility
• Follow-up appointments to monitor the healing process

Alternatives

Alternatives may include:

• Conservative treatments like physical therapy, medications, or injections
• Minimally invasive spinal procedures
• Spinal fusion using different approaches or techniques

The choice of alternatives depends on the individual patient’s condition and overall health.

Patient Experience

During the procedure, the patient is under general anesthesia and will not feel anything. Post-surgery, the patient may experience soreness and stiffness in the neck, managed with medications and physical therapy. Recovery includes some restrictions on physical activities and gradual return to normal function.