21610 Costotransversectomy (separate procedure)

Name of the Procedure:

Costotransversectomy (separate procedure)

Summary

A costotransversectomy is a surgical procedure that involves the removal of a rib and part of a vertebra (spinal bone) to relieve pressure on the spinal cord or nerves. This surgery is typically performed to address conditions affecting the spine and surrounding structures.

Purpose

The purpose of a costotransversectomy is to treat spinal conditions such as tumors, infections, fractures, or degenerative spinal diseases that cause compression of the spinal cord or nerve roots. The goal is to alleviate pain, restore neurological function, and improve the patient's quality of life.

Indications

• Spinal tumors
• Vertebral fractures
• Spinal infections (osteomyelitis, abscesses)
• Spinal stenosis (narrowing of the spinal canal)
• Degenerative spinal diseases (e.g., herniated discs)

Patient criteria:

• Severe spinal cord or nerve root compression
• Symptoms unresponsive to conservative treatments (e.g., physical therapy, medication)
• Progressive neurological deficits

Preparation

• Patients may be required to fast for a certain period before the procedure.
• Medication adjustments may be necessary (patients should consult their doctor).
• Pre-operative imaging studies (MRI, CT scans) and blood tests are typically required.
• Patients may need to undergo a physical examination and anesthesia evaluation.

Procedure Description

1. Anesthesia: The patient is placed under general anesthesia.
2. Incision: A surgical incision is made along the spine, over the area requiring treatment.
3. Exposure: Muscles and tissues are carefully retracted to expose the rib and vertebra.
4. Rib and Vertebra Removal: The surgeon removes the affected rib and part of the adjacent vertebra.
5. Decompression: The spinal cord or nerve roots are decompressed by removing any pathological tissues causing compression.
6. Closure: The incision is closed with sutures or staples.

Tools/Equipment:

• Surgical instruments (scalpels, retractors)
• Imaging guidance systems (fluoroscopy, intraoperative MRI)
• Drills and surgical saws

Duration

The procedure typically takes 2 to 4 hours, depending on the complexity of the case.

Setting

The procedure is performed in a hospital setting, primarily in an operating room equipped for spinal surgeries.

Personnel

• Orthopedic or neurosurgeon
• Anesthesiologist
• Surgical nurses
• Operating room technicians

Risks and Complications

• Infection
• Bleeding
• Nerve damage
• Spinal instability
• Complications related to anesthesia

Benefits

• Relief from pain and neurological symptoms
• Improved spinal stability and function
• Enhanced quality of life

Patients may start to notice benefits shortly after recovery from the surgery, with full benefits typically realized within a few weeks to months.

Recovery

• Hospital stay: Several days for monitoring and initial recovery
• Pain management: Medications and physical therapy
• Restrictions: Limited physical activity and avoidance of heavy lifting for several weeks
• Follow-up: Regular appointments to monitor healing and progress

Alternatives

• Conservative treatments (e.g., medication, physical therapy)
• Minimally invasive spinal surgery
• Vertebroplasty/kyphoplasty for specific fractures
• Pros and cons: Alternatives may offer less risk and shorter recovery times but might not be as effective for severe cases.

Patient Experience

During the procedure, patients won't feel anything due to general anesthesia. Post-surgery, patients may experience pain and discomfort, which can be managed with medication. Physical therapy and gradual return to normal activities will be necessary. Full recovery can take several weeks to months, depending on the individual and the extent of the surgery.