22556 Arthrodesis, anterior interbody technique, including minimal discectomy to prepare interspace (other than for decompression); thoracic

Name of the Procedure:

Arthrodesis, anterior interbody technique, including minimal discectomy to prepare interspace (other than for decompression); thoracic

Summary

This procedure involves fusing two or more vertebrae in the thoracic spine from the front (anterior) aspect. It includes removing a small portion of the intervertebral disc to prepare the space for fusion. This technique stabilizes the spine and alleviates pain caused by various spinal conditions.

Purpose

Medical Condition or Problem: Conditions such as severe spinal instability, deformities, fractures, or certain types of spinal arthritis. Goals/Expected Outcomes: To stabilize the spine, reduce pain, and improve mobility and quality of life.

Indications

• Severe spinal deformity or curvature (e.g., scoliosis or kyphosis)
• Spinal instability due to fractures, tumors, or infections.
• Severe degenerative disc disease unresponsive to conservative treatments.
• Chronic pain not relieved by other treatments.

Preparation

• Pre-procedure Instructions:
  • Fasting for at least 8 hours before surgery.
  • Adjusting or stopping certain medications (e.g., blood thinners) as advised by the doctor.
• Diagnostic Tests:
  • Imaging studies such as X-rays, MRI, or CT scans.
  • Blood tests to check overall health and readiness for surgery.

Procedure Description

1. Anesthesia: General anesthesia is administered to ensure the patient is asleep and pain-free.
2. Incision: A surgical incision is made on the front (anterior) of the chest or abdomen to access the thoracic spine.
3. Discectomy: A small portion of the intervertebral disc is removed to prepare the space for fusion.
4. Bone Graft Placement: A bone graft (from the patient’s body or a donor) or a synthetic material is placed in the space to facilitate the fusion of the vertebrae.
5. Stabilization: Metal plates, screws, or rods may be used to secure the vertebrae while fusion occurs.
6. Closure: The incision is closed with sutures or staples, and a sterile bandage is applied.

Duration

The procedure typically takes between 3 to 6 hours, depending on the complexity of the case.

Setting

Performed in a hospital's surgical suite or an advanced surgical center.

Personnel

• Orthopedic Surgeon or Neurosurgeon
• Anesthesiologist
• Surgical Nurses
• Operating Room Technicians
• Recovery Room Staff

Risks and Complications

• Common Risks: Infection, blood loss, adverse reaction to anesthesia.
• Rare Risks: Nerve damage, failure of the vertebrae to fuse (nonunion), blood clots, complications related to the placement of hardware.
• Management: Risks are managed with antibiotics, surgical techniques, and postoperative care.

Benefits

• Significant pain relief.
• Improved spinal stability and function.
• Potential correction of spinal deformities.
• Enhanced quality of life post-recovery.

Recovery

• Post-procedure Care: Pain management with medications, wound care, and possibly wearing a brace.
• Recovery Time: Initial hospital stay of 3-7 days, with a full recovery period ranging from several weeks to months.
• Restrictions: Limited physical activity; avoiding heavy lifting and strenuous activities.
• Follow-up: Regular follow-up appointments to monitor healing and spinal fusion progress.

Alternatives

• Non-surgical Options: Physical therapy, medication, spinal injections.
• Other Surgical Options: Posterior spinal fusion or minimally invasive techniques.
• Comparison: Non-surgical options tend to be less invasive but may not provide long-term relief. Other surgical options might be considered based on individual patient factors and surgeon recommendation.

Patient Experience

• During Procedure: The patient is under general anesthesia and will not feel pain.
• After Procedure: Pain at the incision site and in the back, managed with medications.
• Comfort Measures: Use of pain relief medications, proper positioning, and gradual increase in activity as tolerated.