22848 Pelvic fixation (attachment of caudal end of instrumentation to pelvic bony structures) other than sacrum (List separately in addition to code for primary procedure)

Name of the Procedure:

Pelvic Fixation (Attachment of Caudal End of Instrumentation to Pelvic Bony Structures) Other than Sacrum

Summary

Pelvic fixation is a surgical procedure that involves attaching the lower end of spinal instrumentation to the bones of the pelvis, excluding the sacrum. This is often performed to stabilize the spine and pelvis due to various conditions such as fractures, deformities, or diseases.

Purpose

Pelvic fixation aims to provide stability and support to the spine and pelvis, especially when the sacrum is not viable for attachment. This procedure helps to ensure proper alignment and function of the spinal column, which can improve mobility and reduce pain.

Indications

• Spinal deformities (e.g., scoliosis)
• Pelvic fractures
• Spinal instability due to tumors or infection
• Severe degenerative spinal conditions
• Failed previous spinal surgery needing additional stabilization

Preparation

• Fasting for at least 8 hours before the procedure
• Medication adjustments as directed by the physician
• Pre-surgical imaging (e.g., X-rays, MRI, CT scans) to plan the surgery
• Blood tests and other diagnostic assessments to ensure patient fitness for surgery

Procedure Description

1. Anesthesia: General anesthesia is administered to the patient.
2. Incision: An incision is made over the lower back or pelvic area, depending on the specific approach and condition being treated.
3. Exposure: The muscles and tissues are carefully moved aside to expose the bony structures of the pelvis.
4. Instrumentation: Special screws, rods, or other hardware are attached to the pelvic bones to secure the spinal instrumentation.
5. Stabilization: Additional hardware may be used to ensure the entire construct is stable and properly aligned.
6. Closure: The incision is closed with sutures or staples, and a sterile dressing is applied.
7. Imaging: Post-operative imaging may be done to confirm proper placement of the hardware.

Duration

The procedure typically takes 3 to 5 hours, depending on the complexity and any additional spinal work required.

Setting

Pelvic fixation is performed in a hospital operating room setting.

Personnel

• Orthopedic surgeon or neurosurgeon specialized in spinal surgery
• Anesthesiologist
• Surgical nurses
• Radiology technician (if intraoperative imaging is used)

Risks and Complications

• Infection
• Bleeding
• Nerve damage
• Hardware failure or displacement
• Non-union or poor healing of the bones
• Blood clots
• Anesthesia-related complications

Benefits

• Improved spinal and pelvic stability
• Reduced pain
• Increased mobility and function
• Prevention of further spinal deformity or collapse

Recovery

• Hospital stay for 3 to 5 days post-surgery
• Pain management with prescribed medications
• Physical therapy to aid in recovery and improve mobility
• Restrictions on heavy lifting and strenuous activities for several weeks
• Follow-up appointments to monitor healing and hardware placement

Alternatives

• Non-surgical treatments such as physical therapy, bracing, or pain management
• Other surgical options like sacral fixation or different forms of spinal fusion
• Pros and cons: Non-surgical options may offer relief without invasive surgery but may not provide lasting stability; alternative surgeries may not be suitable depending on the sacral involvement or individual patient condition.

Patient Experience

During the procedure, the patient will be under general anesthesia and will not feel any pain. Post-operatively, there will be some pain and discomfort at the incision site and around the pelvis, managed with medications. Physical therapy will be necessary to regain strength and mobility, and most patients can expect to return to normal activities within a few months, adhering to medical and physiotherapy advice.