63086 Vertebral corpectomy (vertebral body resection), partial or complete, transthoracic approach with decompression of spinal cord and/or nerve root(s); thoracic, each additional segment (List separately in addition to code for primary procedure)

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, Each Additional Segment

Summary

A vertebral corpectomy is a surgical procedure where part or all of the vertebral body (the thick bone at the front of the spine) in the thoracic spine is removed through an incision in the chest. This is typically done to relieve pressure on the spinal cord or nerve roots.

Purpose

The procedure addresses conditions where there is pressure on the spinal cord or nerves due to fractured vertebrae, tumors, infections, or severe degenerative spinal disease. The goal is to alleviate pain, restore spinal stability, and improve neurological function.

Indications

• Severe back pain unresponsive to conservative treatments
• Spinal tumors or cancers
• Vertebral fractures causing spinal cord compression
• Chronic infections affecting the vertebrae (e.g., osteomyelitis)
• Severe degenerative spinal conditions

Preparation

• Patients are typically instructed to fast for at least 8 hours before surgery.
• Medications may need to be adjusted or paused, particularly blood thinners.
• Preoperative imaging studies such as X-rays, MRI, or CT scans are necessary to plan the surgery.

Procedure Description

1. The patient is placed under general anesthesia.
2. A transthoracic (through the chest) approach is made by making an incision in the side of the chest.
3. The muscles and tissues are carefully moved aside to access the thoracic spine.
4. Part or all of the affected vertebral body is removed.
5. Decompression is performed to relieve pressure on the spinal cord or nerve roots.
6. If needed, spinal fusion or stabilization devices are placed to support the spine.
7. The incision is closed with sutures or staples.

Duration

The procedure typically takes 3 to 5 hours, depending on the complexity and the number of segments needing surgery.

Setting

This procedure is performed in a hospital's surgical operating room due to the need for specialized equipment and postoperative care.

Personnel

• Orthopedic or neurosurgeon specialized in spinal surgery
• Surgical nurses
• Anesthesiologist
• Surgical technologists
• Radiologic technologists (for imaging guidance)

Risks and Complications

• Infection
• Bleeding or hematoma
• Spinal fluid leak
• Nerve damage resulting in weakness or sensory changes
• Respiratory complications due to lung involvement
• Blood clots
• Postoperative pain and stiffness

Benefits

• Relief from chronic pain
• Improved mobility and function
• Stabilization and proper alignment of the spine
• Prevention of further neurological damage

Recovery

• Hospital stay of 5-7 days usually required
• Pain management with medications
• Physical therapy may be necessary to aid in recovery
• Limited physical activity for several weeks; avoid heavy lifting
• Follow-up appointments for wound check and imaging studies to ensure proper healing and spinal stability

Alternatives

• Non-surgical treatments like physical therapy, pain management, and corticosteroid injections
• Less invasive surgical options such as decompression alone without corpectomy
• Radiation therapy or chemotherapy for spinal tumors

Pros and Cons of Alternatives:

• Non-surgical treatments have fewer risks but may not provide sufficient relief for severe conditions.
• Less invasive options may be adequate for minor compression but might not be suitable for more extensive damage.

Patient Experience

• During the procedure, the patient will be under general anesthesia and not feel anything.
• After the procedure, patients might experience pain and discomfort, managed through pain medications.
• Full recovery can take several months, and patients may need assistance with daily activities initially.

Pain management and comfort measures include prescribed pain medications, gradual physical rehabilitation, and support from healthcare providers during the recovery period.