20936 Autograft for spine surgery only (includes harvesting the graft); local (eg, ribs, spinous process, or laminar fragments) obtained from same incision (List separately in addition to code for primary procedure)

Name of the Procedure:

Autograft for Spine Surgery: Harvesting a Graft from Local Sites

Summary

An autograft for spine surgery involves using the patient's own bone, harvested from a local site, to promote spinal fusion or repair. The bone is usually taken from the ribs, the spinous process, or laminar fragments through the same incision made for the primary spinal surgery.

Purpose

The procedure addresses conditions requiring spinal fusion or structural support, often due to degenerative disc disease, spinal deformities, or trauma. The goal is to facilitate bone healing and fusion by implanting the patient's own bone material, which typically integrates well and reduces the risk of graft rejection.

Indications

• Chronic back or neck pain due to degenerative disc disease.
• Spinal deformities like scoliosis or kyphosis.
• Vertebral fractures or instability from trauma.
• Previous spinal surgeries that require additional support.

Preparation

Pre-procedure instructions may include:

• Fasting for at least 6-8 hours before surgery.
• Adjusting or discontinuing certain medications (e.g., blood thinners).
• Undergoing diagnostic tests like MRI or CT scans to assess the spine.

Procedure Description

1. The patient is given local anesthesia with sedation or general anesthesia, depending on the case.
2. An incision is made over the target spinal area.
3. The surgeon harvests bone from a local site, such as ribs, the spinous process, or laminar fragments, through the same incision.
4. The harvested bone is prepared and placed into the spine to promote fusion.
5. The surgical site is closed with sutures or staples.

Tools and equipment used may include scalpels, bone chisels, surgical drills, and specialized instruments for handling and placing bone grafts.

Duration

The procedure typically takes 1 to 3 hours, depending on the complexity of the primary spinal surgery.

Setting

Performed in a hospital or surgical center equipped for spine surgeries.

Personnel

• Orthopedic or Neurosurgeon
• Scrub Nurse and Circulating Nurse
• Anesthesiologist or Nurse Anesthetist
• Surgical Technologist

Risks and Complications

• Common risks: infection, blood loss, and anesthesia-related issues.
• Rare risks: nerve damage, non-union (failure of the bone to heal), and chronic pain at the graft site.
• Management includes antibiotics for infections and pain medication for post-operative discomfort.

Benefits

• High compatibility since the graft is the patient’s own tissue.
• Reduced risk of graft rejection or disease transmission.
• Can enhance the stability and functionality of the spine.

Recovery

• Initial hospital stay of 1-3 days, depending on the primary procedure.
• Post-procedure care includes pain management, limited movement, and wound care.
• Full recovery and fusion can take between 3 to 12 months.
• Follow-up appointments to monitor healing progress.

Alternatives

• Allografts: Donor bone used, with a higher risk of rejection or disease transmission.
• Synthetic bone grafts: Man-made materials that may not integrate as naturally.
• Pros and cons: Autografts have the highest success rates but require an additional surgical site for harvesting.

Patient Experience

• The patient may experience discomfort at both the spinal and harvest sites.
• Pain is managed with prescribed medications.
• Recovery involves gradual resumption of activities, with physical therapy recommended to enhance strength and mobility.