22633 Arthrodesis, combined posterior or posterolateral technique with posterior interbody technique including laminectomy and/or discectomy sufficient to prepare interspace (other than for decompression), single interspace and segment; lumbar

Name of the Procedure:

Arthrodesis (spinal fusion), combined posterior or posterolateral technique with posterior interbody technique including laminectomy and/or discectomy sufficient to prepare interspace (other than for decompression), single interspace and segment; lumbar.

Summary

Spinal fusion, also known as arthrodesis, is a surgical procedure that combines techniques to stabilize the lumbar spine by fusing two or more vertebrae. It involves posterior or posterolateral approaches and may include the removal of a herniated disc or bony structures to prepare the interspace for fusion.

Purpose

This procedure addresses conditions causing instability or pain in the lower spine, such as degenerative disc disease, spondylolisthesis, or severe spinal stenosis. The goal is to fuse the affected vertebrae to provide stability, reduce pain, and improve overall spinal function.

Indications

• Chronic lower back pain unresponsive to conservative treatments
• Degenerative disc disease
• Spondylolisthesis (slipped vertebrae)
• Severe spinal stenosis with instability
• Spinal deformities like scoliosis

Preparation

• Fasting typically required from midnight before the surgery
• Discontinuing certain medications as advised (e.g., blood thinners)
• Pre-operative imaging studies, such as X-rays or MRI scans
• Medical evaluation and anesthesia consultation

Procedure Description

1. Patient positioned and anesthetized (general anesthesia).
2. An incision made in the back to access the lumbar spine.
3. Laminectomy and/or discectomy performed to remove any bone or disc material.
4. Placement of bone graft material and/or implants between vertebrae.
5. Stabilization with rods and screws as necessary.
6. Closure of the incision site and application of sterile dressings.

Duration

The procedure typically takes 3 to 6 hours, depending on complexity.

Setting

Usually performed in a hospital surgical suite or specialized surgical center.

Personnel

• Orthopedic or neurosurgeon
• Anesthesiologist
• Surgical nurses
• Scrub technician

Risks and Complications

• Infection
• Bleeding
• Nerve damage
• Non-union of the fused vertebrae
• Hardware failure or migration

Benefits

• Reduced pain
• Increased spinal stability
• Improved functionality and quality of life Typically, benefits are noticed within weeks to months as healing occurs.

Recovery

• Hospital stay of 2 to 4 days
• Pain management with prescribed medications
• Physical therapy beginning a few weeks post-surgery
• Gradual return to normal activities over 3 to 6 months
• Follow-up appointments to monitor healing

Alternatives

• Physical therapy
• Pain management injections
• Medical management with medications
• Other surgical options like artificial disc replacement Pros and cons depend on the individual's condition and overall health.

Patient Experience

• General anesthesia will ensure the patient feels no pain during the procedure.
• Postoperative pain managed with medications.
• Gradual return to activities as per physician guidance.
• Physical therapy will assist in regaining strength and mobility.

This procedure aims to offer significant relief and improve the patient's quality of life through the stabilization of the lumbar spine.