Insertion of intervertebral biomechanical device(s) (eg, synthetic cage, mesh) with integral anterior instrumentation for device anchoring (eg, screws, flanges), when performed, to vertebral corpectomy(ies) (vertebral body resection, partial or complete)
CPT4 code
Name of the Procedure:
Insertion of intervertebral biomechanical device(s) (e.g., synthetic cage, mesh) with integral anterior instrumentation for device anchoring (e.g., screws, flanges) to vertebral corpectomy(ies) (vertebral body resection, partial or complete)
Common name(s): Spinal cage insertion with anterior instrumentation, Vertebral body replacement.
Summary
In this procedure, a synthetic device (such as a cage or mesh) is inserted between the vertebrae after one or more vertebral bodies have been partially or completely removed. This device helps stabilize the spine, and it is anchored in place using anterior instrumentation like screws or flanges.
Purpose
This procedure is primarily performed to address conditions that cause instability or deformity in the spine. It aims to stabilize the spine, relieve pain, and preserve or restore spinal alignment.
Indications
- Severe spinal degenerative disc disease
- Spinal tumors
- Vertebral fractures
- Severe spinal deformities
- Chronic, debilitating back pain unresponsive to conservative treatments
Preparation
- Fasting for at least 8 hours before the procedure
- Discontinuation of certain medications as advised by the physician
- Pre-procedure imaging studies like MRI or CT scans
- Preoperative medical evaluation and blood tests
Procedure Description
- The patient is placed under general anesthesia.
- An incision is made in the anterior (front) part of the body to access the affected vertebrae.
- The surgeon removes the damaged or diseased vertebral body(ies) (corpectomy).
- A synthetic cage or mesh device is inserted into the space where the vertebral body was removed.
- Instrumentation such as screws or flanges is used to anchor the device securely in place.
- The incision is closed with sutures or staples.
Duration
The procedure typically takes 3 to 6 hours, depending on the complexity and number of vertebrae involved.
Setting
The procedure is performed in a hospital operating room.
Personnel
- Orthopedic surgeon or neurosurgeon
- Anesthesiologist
- Surgical nurses
- Operating room technicians
Risks and Complications
- Infection
- Bleeding
- Damage to surrounding nerves or blood vessels
- Implant failure or dislodgement
- Spinal fluid leak
- Reaction to anesthesia
- Blood clots
Benefits
- Improved spinal stability
- Reduction in pain and discomfort
- Minimized risk of future vertebral fractures
- Potential improvement in quality of life and mobility
Recovery
- Hospital stay of several days
- Pain management with medications
- Gradual increase in physical activity as tolerated
- Physical therapy may be required
- Follow-up appointments with the surgeon
- Full recovery can take several weeks to months
Alternatives
- Conservative treatments like physical therapy, medications, and spinal injections
- Other surgical options such as spinal fusion without corpectomy
- Pros and cons: Conservative treatments might not provide lasting relief, while other surgical options may not be suitable for severe conditions.
Patient Experience
- Pain and discomfort initially, managed with medication
- Restricted movement during early recovery period
- Gradual improvement in symptoms with adherence to post-operative care and physical therapy