Removal of posterior segmental instrumentation
CPT4 code
Name of the Procedure:
Removal of Posterior Segmental Instrumentation (Spinal Instrumentation Removal)
Summary
The removal of posterior segmental instrumentation involves taking out rods, screws, or plates that were previously implanted in the spine. This procedure is often performed when the instrumentation is no longer needed, causing complications, or has failed.
Purpose
The procedure addresses issues related to spinal hardware, such as pain, infection, or implant failure. The goal is to alleviate symptoms, restore normal spinal function, and improve overall quality of life.
Indications
- Persistent back pain or discomfort related to spinal hardware
- Infection at the site of the instrumentation
- Hardware malfunction or migration
- Completion of the intended support period
- Overlying skin irritation or breakdown
Preparation
- Fasting for at least 8 hours before the procedure
- Adjustments to current medications as directed by the surgeon
- Preoperative diagnostic tests, such as X-rays or MRIs, to assess the specific location and condition of the hardware
- Blood tests and a thorough medical evaluation
Procedure Description
- The patient is placed under general anesthesia.
- An incision is made along the original scar or close to the insertion site.
- The surrounding tissues are carefully dissected to expose the hardware.
- Screws, rods, or plates are systematically removed using specialized tools.
- The surgical site is checked for any signs of infection or complications.
- The wound is closed in layers using sutures or staples.
- A sterile dressing is applied to the incision site.
Duration
The procedure typically takes 1 to 3 hours, depending on the complexity and number of segments involved.
Setting
The procedure is performed in a hospital or surgical center equipped with appropriate facilities for spine surgery.
Personnel
- Orthopedic or neurosurgeon
- Anesthesiologist
- Surgical nurses
- Surgical technologists
Risks and Complications
- Infection
- Blood loss
- Nerve damage
- Spinal instability
- Recurrence of spinal condition
- Adverse reactions to anesthesia
Benefits
- Relief from pain or discomfort caused by hardware
- Resolution of infections or inflammation
- Improved mobility and quality of life
- The benefits may be realized within a few weeks post-surgery.
Recovery
- Initial recovery in the hospital for 1 to 3 days
- Pain management with prescribed medications
- Limited physical activity for several weeks
- Follow-up appointments for wound checks and physical assessments
- Physical therapy may be recommended
Alternatives
- Conservative management with pain relief medications or physical therapy
- Revision surgery to replace or adjust the hardware
- Observation with regular monitoring if symptoms are mild
Patient Experience
During the procedure, the patient will be under general anesthesia and will not feel any pain. Postoperatively, there may be some discomfort, which is managed with pain medications. Gradually, the patient should experience relief from the symptoms that necessitated hardware removal.