22870 Insertion of interlaminar/interspinous process stabilization/distraction device, without open decompression or fusion, including image guidance when performed, 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 Open Decompression or Fusion, including Image Guidance when Performed, Lumbar; Second Level

Summary

This procedure involves placing a device between the interlaminar or interspinous processes of the spine in the lumbar region to provide stabilization and relief. It is less invasive than traditional spinal fusion and does not involve decompression. Image guidance may be used for accurate placement.

Purpose

• Medical Condition: Treats lumbar spinal stenosis and may relieve related pain and pressure on spinal nerves.
• Goals: Stabilize the lumbar spine, maintain or improve mobility, and alleviate pain caused by spinal stenosis without the need for significant open surgery.

Indications

• Persistent lower back pain
• Lumbar spinal stenosis with moderate to severe symptoms
• Patients who have not responded to conservative treatments such as physical therapy or medications
• Suitable for patients who may not be ideal candidates for more invasive spinal surgeries

Preparation

• Fasting may be required prior to the procedure
• Adjustments to certain medications (e.g., blood thinners) might be needed
• Pre-procedure imaging studies, such as MRI or CT scans, to guide the intervention

Procedure Description

1. Patient is positioned to expose the lumbar region.
2. Local or general anesthesia is administered.
3. Using fluoroscopic or other imaging guidance, the interlaminar/interspinous space is located.
4. A small incision is made.
5. The stabilization/distraction device is carefully inserted into the targeted interlaminar or interspinous space.
6. Position is confirmed through imaging and the incision is closed.

Duration

Typically takes about 1 to 2 hours.

Setting

• Performed in a hospital, outpatient clinic, or surgical center.

Personnel

• Surgeon (orthopedic or neurosurgeon specialized in spine procedures)
• Anesthesiologist/nurse anesthetist
• Surgical nurses and technicians
• Radiologic technologist (for image guidance)

Risks and Complications

• Common risks: Pain at the incision site, infection, minor bleeding or bruising.
• Rare but serious risks: Nerve damage, device migration or failure, adverse reactions to anesthesia.

Benefits

• Minimally invasive compared to traditional spinal fusion.
• Reduced recovery time and hospital stay.
• Potential improvement in mobility and significant pain relief.

Recovery

• Post-procedure care includes managing pain with medications and keeping the incision site clean.
• Patients are usually able to walk within a few hours post-surgery.
• Complete recovery and return to normal activities generally within a few weeks.
• Follow-up appointments to monitor healing and device position.

Alternatives

• Conservative treatments: Physical therapy, medications, epidural steroid injections.
• More invasive surgeries: Spinal fusion or decompression surgeries.
• Pros and cons: Less invasive procedures have quicker recovery but may offer less significant pain relief; more invasive surgeries might provide more lasting results but come with higher risk and longer recovery.

Patient Experience

• During the procedure: Patient will be under anesthesia and should not feel pain.
• After the procedure: Some pain and discomfort at the incision site, manageable with medication.
• Post-procedure comfort measures include prescribed pain relief, instructions on movements to avoid, and gradual return to normal activities.