22868 Insertion of interlaminar/interspinous process stabilization/distraction device, without fusion, including image guidance when performed, with open decompression, lumbar; second level (List separately in addition to code for primary procedure)

Name of the Procedure:

Insertion of interlaminar/interspinous process stabilization/distraction device, without fusion, including image guidance when performed, with open decompression, lumbar; second level

Summary

This surgical procedure involves placing a device between the vertebrae in your lower back to stabilize and decompress the spine. It is performed using imaging guidance to ensure accurate placement and often includes removing tissue to relieve pressure on the spinal nerves. This description covers the additional insertion at a second spinal level, beyond the primary procedure.

Purpose

The procedure aims to alleviate lower back pain and other symptoms caused by conditions such as spinal stenosis, degenerative disc disease, or spondylolisthesis. By stabilizing the vertebrae and relieving pressure on the spinal cord and nerves, patients can expect reduced pain and improved mobility.

Indications

• Chronic lower back pain not relieved by conservative treatments
• Symptoms such as numbness, tingling, or weakness in the legs
• Diagnosed conditions like spinal stenosis, degenerative disc disease, or spondylolisthesis
• Patients with documented lumbar spine instability or deformity

Preparation

• Patients may need to fast for a specified period before the procedure.
• Blood tests, imaging studies (e.g., MRI or CT scans), and a physical examination are typically required.
• Adjustments to medications, particularly blood thinners, may be necessary.

Procedure Description

1. An incision is made over the affected spinal segment.
2. Soft tissues are carefully retracted to expose the spine.
3. Open decompression involves the removal of tissues (e.g., bone or ligament) compressing the spinal nerves.
4. The interlaminar/interspinous process stabilization device is inserted between the vertebrae.
5. Image guidance ensures precise placement of the device.
6. The site is closed with sutures or staples, and a sterile bandage is applied.

Tools used:

• Spinal stabilization device
• Imaging equipment (e.g., X-ray, fluoroscopy)
• Surgical instruments for decompression

Anesthesia:

• General anesthesia is commonly used to ensure the patient is comfortable and pain-free.

Duration

The procedure typically lasts between 2 to 3 hours, depending on complexity and additional levels involved.

Setting

Usually performed in a hospital or surgical center equipped for advanced spinal surgeries.

Personnel

• Orthopedic or neurosurgeon specialized in spinal procedures
• Surgical nurses
• Anesthesiologist
• Radiologic technologist

Risks and Complications

• Infection
• Bleeding
• Nerve damage leading to numbness or weakness
• Device failure or migration
• Pain at the surgical site
• Potential need for additional surgery

Benefits

• Relief from chronic back pain
• Improved mobility and function
• Stabilization of the spine
• Quick recovery, often with reduced hospital stay compared to fusion surgeries

Recovery

• Patients may need to stay in the hospital for 1-2 days.
• Pain management includes medications and sometimes physical therapy.
• Restrictions on activities, such as lifting heavy objects or extensive bending, are often recommended for several weeks.
• Follow-up appointments to monitor healing and device placement.

Alternatives

• Conservative treatments like physical therapy, medications, and steroid injections
• Spinal fusion surgery
• Minimally invasive decompression procedures
• Pros of alternatives include less invasive nature of conservative treatments, while cons may include less permanent relief of symptoms compared to stabilization devices.

Patient Experience

• Patients will be under general anesthesia during the procedure, ensuring they feel no pain.
• Post-procedure, patients may experience soreness and will receive pain management support.
• Physical activity may be limited during the initial recovery phase, with gradual return to normal activities under medical advice.