20938 Autograft for spine surgery only (includes harvesting the graft); structural, bicortical or tricortical (through separate skin or fascial incision) (List separately in addition to code for primary procedure)

Name of the Procedure:

Autograft for Spine Surgery — Structural, Bicortical or Tricortical Graft Harvest (through separate skin or fascial incision)

Summary

In spinal surgery, an autograft involves taking bone tissue from one part of the patient's body (typically the pelvis) to be used to support or replace damaged spinal structures. This procedure involves making a separate incision to harvest the graft.

Purpose

The autograft procedure is designed to enhance spinal stability and facilitate bone fusion, which is essential for maintaining spinal alignment and reducing pain due to spinal disorders or injuries.

Indications

• Degenerative disc disease
• Spinal deformities (e.g., scoliosis)
• Spinal fractures or trauma
• Conditions requiring spinal fusion
• Failed previous spinal surgeries requiring revision

Patient criteria:

• Generally good health
• No contraindications for anesthesia
• Suitable bone quality for harvesting

Preparation

• Fasting for at least 8 hours before surgery
• Medication adjustments (e.g., blood thinners)
• Preoperative imaging studies (e.g., X-rays, MRI, CT scan)
• Physical examination and medical history review

Procedure Description

1. Anesthesia: Patient is administered general anesthesia.
2. Incision: A separate small incision is made at the donor site (often the iliac crest in the pelvis).
3. Bone Harvesting: The surgeon removes a portion of bone tissue, ensuring the structure of the donor site remains intact.
4. Closure: The incision at the donor site is closed using sutures or staples.
5. Transplantation: The harvested bone is then utilized for the primary spinal surgery, where it helps to stabilize and support the spine.

Tools Used:

• Surgical scalpels and retractors
• Bone saw or osteotome
• Sutures or surgical staples

Duration

The harvesting procedure typically takes around 30 minutes to 1 hour, in addition to the time required for the primary spinal surgery.

Setting

Performed in a hospital operating room or a specialized surgical center.

Personnel

• Orthopedic or neurosurgeon specializing in spinal surgery
• Anesthesiologist
• Surgical nurses and assistants

Risks and Complications

• Infection at the donor or surgical site
• Bleeding or hematoma
• Pain at the donor site
• Nerve injury
• Delayed bone healing or nonunion
• Scar formation

Benefits

• Increased likelihood of successful spinal fusion
• Reduced risk of graft rejection since the bone is harvested from the patient's own body
• Enhanced structural support for the spine

Benefits realization can begin within weeks, with full fusion typically taking several months.

Recovery

• Hospital stay of 2-5 days
• Pain management with medications
• Avoid heavy lifting or bending for 6-8 weeks
• Follow-up appointments for monitoring fusion progress
• Physical therapy may be recommended

Alternatives

• Allograft: Bone from a donor, risk of rejection
• Synthetic grafts: Lower risk of disease transmission but may not integrate as well
• Orthobiologics: Emerging treatments with varying success rates

Patient Experience

During the procedure, the patient will be under general anesthesia and feel no pain. Post-surgery, they may experience discomfort at the donor site and along the spine, manageable with prescribed pain medications. The incision might be sore for a few weeks, and activities will be restricted to promote healing.

Pain levels will vary, but effective pain management strategies and physical therapy can significantly improve comfort and recovery outcomes.