22845 Anterior instrumentation; 2 to 3 vertebral segments (List separately in addition to code for primary procedure)

Name of the Procedure

Anterior instrumentation; 2 to 3 vertebral segments
Common Names: Spinal fusion, anterior spinal fixation

Summary

Anterior instrumentation is a surgical procedure where metal rods, screws, or plates are inserted from the front (anterior) of the spine to stabilize and support 2 to 3 vertebral segments. This technique is often used in conjunction with spinal fusion.

Purpose

This procedure is designed to address spinal instability, deformity, or trauma involving the vertebrae. The primary goal is to stabilize the affected spinal segments, reduce pain, and improve spinal alignment and function.

Indications

• Severe spinal deformities like scoliosis or kyphosis
• Spinal fractures or trauma
• Degenerative disc disease
• Spinal tumors
• Instability due to previous spinal surgeries

Preparation

• Fasting typically required for 8-12 hours prior to surgery
• Adjustment or discontinuation of certain medications, especially blood thinners
• Preoperative imaging studies such as X-rays, MRI, or CT scans
• Blood tests and a physical exam to assess overall health

Procedure Description

1. Anesthesia: General anesthesia is administered to ensure the patient remains unconscious and pain-free.
2. Incision: A surgical incision is made in the abdomen to access the spine from the front.
3. Exposure: Vital structures are carefully moved aside to expose the vertebral segments.
4. Placement: Metal rods, screws, or plates are attached to the vertebrae to stabilize the spine.
5. Fusion: Bone graft material may be used to facilitate spinal fusion and promote bone healing.
6. Closure: The incision is closed with sutures or staples, and a sterile dressing is applied.

Tools and Equipment: Surgical instruments, image guidance systems, metal rods, screws, plates, and bone graft material.

Duration

The procedure typically takes between 2 to 4 hours, depending on the complexity of the case.

Setting

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

Personnel

• Orthopedic spine surgeon or neurosurgeon
• Surgical nurses
• Anesthesiologist
• Surgical technologists

Risks and Complications

Common risks:

• Infection
• Blood loss
• Nerve injury

Rare risks:

• Non-union or failure of the bone to heal properly
• Hardware failure or movement
• Adjacent segment degeneration

Benefits

• Improved spinal stability and alignment
• Reduction or elimination of pain
• Enhanced mobility and quality of life
• Benefits are typically realized within a few weeks to months post-surgery

Recovery

• Hospital stay of 3-5 days post-surgery
• Pain management with medications
• Physical therapy and rehabilitation starting a few weeks after discharge
• Restrictions on heavy lifting and strenuous activities for several months
• Follow-up appointments to monitor healing and hardware placement

Alternatives

• Non-surgical treatments such as physical therapy, medications, and bracing
• Less invasive surgical options, depending on the specific condition
• Pros and cons: Non-surgical options may provide relief without the risks of surgery but might not adequately address severe instability or deformity.

Patient Experience

During the procedure, the patient will be under general anesthesia and will not feel or remember anything. Post-surgery, they may experience discomfort or pain, which will be managed with medications. Physical therapy will be necessary for rehabilitation, and gradual improvement is expected over several months.