22840 Posterior non-segmental instrumentation (eg, Harrington rod technique, pedicle fixation across 1 interspace, atlantoaxial transarticular screw fixation, sublaminar wiring at C1, facet screw fixation) (List separately in addition to code for primary proced

Name of the Procedure:

Posterior non-segmental instrumentation (Common techniques include the Harrington rod technique, pedicle fixation across 1 interspace, atlantoaxial transarticular screw fixation, sublaminar wiring at C1, and facet screw fixation).

Summary

Posterior non-segmental instrumentation is a surgical technique involving the use of rods, screws, and other hardware to stabilize the spine. This procedure is used to correct spine deformities or stabilize the spine after a fracture or surgery.

Purpose

The procedure addresses spinal deformities such as scoliosis, kyphosis, or spinal fractures. The main goals are to stabilize the spinal segments, reduce pain, and improve spinal alignment and overall function.

Indications

• Severe spinal deformities (e.g., scoliosis, kyphosis)
• Spinal instability or fractures
• Degenerative spinal conditions requiring stabilization
• Failed previous spinal surgeries
• Conditions compromising the structural integrity of the spine

Preparation

• Patients may be required to fast for several hours before the procedure.
• Preoperative assessments might include X-rays, CT scans, or MRIs.
• Blood tests and a thorough medical history review are usually conducted.
• Medication adjustments, particularly for blood thinners, might be necessary as per the physician's instructions.

Procedure Description

1. Anesthesia: The patient will be placed under general anesthesia.
2. Incision: A midline incision is made on the back along the affected spinal segment.
3. Exposure: Muscles and tissues are moved aside to expose the vertebrae.
4. Placement of Hardware: Rods, screws, or wires are strategically placed based on the deformity and stabilization requirements. Techniques like the Harrington rod, pedicle screws, or sublaminar wiring are employed.
5. Fixation: The hardware is secured to stabilize the spine.
6. Closure: The incision is sutured, and a sterile dressing is applied.

Duration

The procedure typically takes between 3 to 6 hours, depending on the complexity and extent of the surgery required.

Setting

The procedure is performed in a hospital operating room equipped with advanced imaging technology to guide the instrumentation.

Personnel

• Orthopedic surgeon or neurosurgeon
• Anesthesiologist
• Surgical nurses
• Technicians assisting with imaging and monitoring equipment

Risks and Complications

• Common risks include infection, bleeding, and pain at the surgical site.
• Rare complications may include nerve damage, hardware malfunction, or failure, spinal cord injury, and adverse reactions to anesthesia.
• Management includes antibiotics for infections, revision surgeries for hardware issues, and pain medications.

Benefits

• Stabilization and alignment of the spine
• Pain relief and improved function
• Prevention of further spinal deformity progression
• Enhanced quality of life

Recovery

• Patients might be hospitalized for several days post-surgery.
• Initial recovery includes pain management, antibiotics, and physical therapy.
• Instructions often include avoiding heavy lifting, bending, or twisting.
• Regular follow-up appointments for monitoring and possibly imaging to ensure proper healing and hardware position.
• Full recovery can take several months.

Alternatives

• Non-surgical options such as physical therapy, bracing, or medications.
• Minimally invasive surgical techniques if appropriate.
• Other spinal stabilization procedures depending on the specific spinal issue.

Pros and Cons of Alternatives

• Non-surgical options: Less risk and no surgical recovery but may not provide sufficient stabilization.
• Minimally invasive techniques: Less tissue damage and faster recovery but might not be suitable for severe cases.

Patient Experience

• Patients will be under general anesthesia during the procedure, so they will not feel any pain.
• Postoperative pain and discomfort are managed with medications.
• Physical therapy is often required to aid in recovery, improve mobility, and strengthen the muscles supporting the spine.
• Patients may experience some restrictions and a gradual return to normal activities based on their progress and the surgeon’s recommendations.