Removal of posterior nonsegmental instrumentation (eg, Harrington rod)
CPT4 code
Name of the Procedure:
Removal of posterior nonsegmental instrumentation (e.g., Harrington rod)
Summary
This is a surgical procedure that involves the removal of devices, such as Harrington rods, that were previously placed in the spine to correct or stabilize spinal deformities.
Purpose
The primary goal is to remove spinal hardware that is no longer needed, is causing pain, or is associated with complications.
Indications
- Pain or discomfort from the hardware
- Infection surrounding the hardware
- Mechanical failure of the hardware
- Hardware impingement on nerves or spinal cord
- Completed spinal fusion where hardware is no longer necessary
Preparation
- Patients may need to fast for 8 hours prior to the procedure.
- Medication adjustments might be necessary, particularly blood thinners.
- Preoperative imaging studies, including X-rays or MRIs, can be useful for planning the surgery.
- Pre-anesthetic assessment is required.
Procedure Description
- The patient is placed under general anesthesia.
- An incision is made along the previous surgical site on the back.
- Muscles and tissues are retracted to expose the spine.
- The hardware (e.g., Harrington rods) is identified and carefully removed.
- The surgical site is examined for any further issues.
- The incision is closed with sutures or staples.
- A sterile dressing is applied to the wound.
Duration
Typically, the procedure lasts between 2 to 4 hours, but this can vary based on the complexity and extent of the hardware removal.
Setting
The procedure is usually performed in a hospital or a specialized surgical center.
Personnel
- A spine surgeon
- Surgical nurses
- An anesthesiologist
- Surgical technologists may also assist
Risks and Complications
- Infection
- Bleeding
- Nerve damage
- Anesthesia-related risks
- Failure to relieve symptoms
- Spinal instability if fusion is incomplete
Benefits
- Relief from pain or discomfort due to the hardware
- Resolution or prevention of infection
- Improved mobility and quality of life
- Removal of potential impediments to future MRI or imaging studies
Recovery
- Hospital stay may be required for 1-3 days
- Pain management with prescribed medications
- Physical therapy may be recommended
- Follow-up appointments for wound checks and imaging
- Walking and limited activity are encouraged, but avoid heavy lifting or strenuous activity for about 4-6 weeks
Alternatives
- Conservative management with medications and physical therapy if symptoms are mild
- Diagnostic nerve blocks to determine if pain is coming from the hardware
- Leaving the hardware in place if it is not causing significant issues
Patient Experience
Patients may experience pain and soreness at the incision site postoperatively. Pain management will be provided through medications. Initial discomfort is expected, but this should decrease over time with proper care and rehabilitation. Potential improvement in symptoms can often be noted within a few weeks.