22534 Arthrodesis, lateral extracavitary technique, including minimal discectomy to prepare interspace (other than for decompression); thoracic or lumbar, each additional vertebral segment (List separately in addition to code for primary procedure)

Name of the Procedure:

Arthrodesis, lateral extracavitary technique, including minimal discectomy to prepare interspace (other than for decompression); thoracic or lumbar, each additional vertebral segment (List separately in addition to code for primary procedure)

Summary

Arthrodesis, commonly known as spinal fusion, involves permanently joining two or more vertebrae in the spine. Using a lateral extracavitary technique, this procedure targets the thoracic or lumbar spine and includes removing a small portion of the disc to prepare the interspace without aiming for decompression.

Purpose

This procedure addresses issues such as severe spinal instability, deformities, or degenerative disc disease. The goal is to stabilize the spine, reduce pain, and improve functional movement by fusing the affected vertebrae.

Indications

• Chronic, severe back pain not relieved by other treatments.
• Spinal deformities like scoliosis or kyphosis.
• Spinal instability due to conditions like spondylolisthesis.
• Degenerative disc disease.
• Trauma or fractures affecting the vertebrae.

Patient criteria:

• Failed conservative treatments.
• Diagnosed conditions showing instability or deformity.
• Good overall health to withstand surgery.

Preparation

• Pre-procedure fasting for several hours.
• Adjustments to current medications, especially blood thinners.
• Preoperative imaging tests such as MRIs or CT scans.
• Blood tests and overall health assessment.

Procedure Description

1. Anesthesia: General anesthesia is administered.
2. Incision: A lateral incision is made on the side of the body to access the spine.
3. Exposure: Muscle and tissue are carefully retracted to expose the vertebrae.
4. Discectomy: Minimal discectomy is performed by removing part of the intervertebral disc.
5. Preparation: Preparing the interspace between vertebrae for fusion.
6. Fusion: Placement of bone grafts and/or implants to facilitate fusion.
7. Closure: The incision is closed with sutures and sterile dressing applied.

Tools and technology used include surgical retractors, bone graft materials, and sometimes spinal implants or screws.

Duration

Typically, the procedure takes 3-6 hours, depending on the number of vertebral segments being fused.

Setting

The procedure is usually performed in a hospital operating room equipped with specialized spinal surgery facilities.

Personnel

• Orthopedic or neurosurgeon.
• Anesthesiologist.
• Surgical nurses.
• Surgical technologists.

Risks and Complications

Common risks:

• Infection
• Blood loss
• Nerve damage

Rare risks and complications:

• Failure of the bone to fuse (nonunion)
• Hardware malfunction or displacement
• Adjacent segment degeneration

Management includes antibiotics for infections and additional surgeries if nonunion or hardware issues occur.

Benefits

• Stabilization of the spine.
• Relief from chronic pain.
• Improved spinal alignment and function. Expected benefits can be realized within a few months, with full fusion occurring in 6-12 months.

Recovery

• Hospital stay for a few days post-procedure.
• Pain management with medications.
• Physical therapy to aid recovery.
• Restrictions on heavy lifting or strenuous activities for several weeks.
• Follow-up visits to monitor fusion progress and overall recovery.

Alternatives

• Conservative treatments: physical therapy, medications, spinal injections.
• Less invasive spine surgeries: laminectomy, laminoplasty.
• Each alternative varies in effectiveness; spinal fusion is considered when others have failed.

Patient Experience

During the procedure, patients are under general anesthesia and won’t feel pain. Post-surgery, there will be discomfort and pain managed with medications. Patients may experience limited mobility initially and will gradually improve with physical therapy and time. Comfort measures include pain medications, physical therapy, and support from medical staff.