Vertebral corpectomy (vertebral body resection), partial or complete, transthoracic approach with decompression of spinal cord and/or nerve root(s); thoracic, single segment
CPT4 code
Name of the Procedure:
Vertebral Corpectomy (Vertebral Body Resection), Partial or Complete, Transthoracic Approach with Decompression of Spinal Cord and/or Nerve Root(s); Thoracic, Single Segment.
Summary
A vertebral corpectomy is a surgical procedure where part or all of a vertebra in the thoracic spine is removed through the chest. This procedure is typically done to relieve pressure on the spinal cord or nerve roots caused by various conditions.
Purpose
The procedure addresses spinal conditions that cause compression of the spinal cord or nerve roots, such as spinal tumors, fractures, infections, or severe degenerative diseases. The goal is to reduce pain, restore function, and prevent further neurological damage.
Indications
- Persistent thoracic back pain unresponsive to conservative treatments.
- Neurological deficits (e.g., weakness, numbness) indicating spinal cord compression.
- Spinal tumors, trauma, or infection.
- Severe thoracic spinal deformities causing neural compression.
Preparation
- Patients may need to fast for at least 8 hours before the procedure.
- Adjustments or cessation of certain medications (e.g., blood thinners) as advised by the surgeon.
- Pre-procedure imaging tests such as MRI, CT scans, and X-rays.
- Routine blood tests and cardiovascular assessments to ensure fitness for surgery.
Procedure Description
- Anesthesia: The patient is placed under general anesthesia.
- Incision: A thoracic surgeon makes a transthoracic incision to access the spine.
- Exposure: The rib cage is moved aside to expose the vertebral body.
- Resection: The affected vertebra is partially or completely removed.
- Decompression: Careful decompression of the spinal cord and/or nerve roots is performed.
- Stabilization: Implants such as bone grafts, screws, or plates may be used to stabilize the spine.
- Closure: The incision is closed with sutures, and a drain may be placed to remove excess fluids.
Duration
The procedure typically takes between 3 to 6 hours depending on the complexity of the case.
Setting
This surgery is performed in a hospital operating room.
Personnel
- Orthopedic or Neurosurgeon
- Thoracic Surgeon
- Anesthesiologist
- Surgical Nurses
- Radiology Technicians
Risks and Complications
- Infection
- Excessive bleeding
- Injury to spinal cord or nerves, potentially leading to paralysis
- Respiratory complications due to the transthoracic approach
- Blood clots
- Potential need for additional surgeries
Benefits
The procedure can significantly reduce pain, restore mobility, and improve neurological function. Benefits are often realized gradually over weeks to months post-surgery.
Recovery
- Hospital stay: Typically 5-7 days
- Initial recovery: 4-6 weeks with limited activities
- Full recovery: Up to 6 months with physical therapy
- Follow-up appointments for monitoring and imaging
Alternatives
- Conservative treatments (physical therapy, medication)
- Minimally invasive spinal surgery (if applicable)
- Spinal fusion without corpectomy
- Each alternative has varying levels of invasiveness, effectiveness, and recovery times.
Patient Experience
During the procedure, the patient will be under general anesthesia and will not feel any pain. Post-operatively, they may experience pain at the incision site, managed with pain medications. Patients can expect some discomfort and limited mobility initially, with gradual improvement as they heal with appropriate care and rehabilitation.