22869 Insertion of interlaminar/interspinous process stabilization/distraction device, without open decompression or fusion, including image guidance when performed, lumbar; single level

Name of the Procedure:

Insertion of Interlaminar/Interspinous Process Stabilization/Distraction Device, Without Open Decompression or Fusion, Including Image Guidance When Performed, Lumbar; Single Level

Summary

This procedure involves the insertion of a device between the bones in the lower spine (lumbar region) to stabilize or create space between them. No open surgery or fusion of the vertebrae is required, and imaging technology helps guide the process.

Purpose

The procedure aims to alleviate pain and improve function for individuals with certain types of lower back problems, such as spinal stenosis. The device helps keep the spine aligned and decompresses any nerves that may be pinched.

Indications

• Chronic lower back pain
• Lumbar spinal stenosis
• Patients who are not candidates for more invasive surgeries
• Symptoms like numbness, weakness, or leg pain that affect daily activities

Preparation

• The patient may need to fast for several hours prior to the procedure.
• Adjustments in medications, particularly blood thinners, may be necessary.
• Pre-procedure imaging tests, such as MRI or CT scans, will be performed to guide the insertion process.

Procedure Description

1. The patient is positioned lying face down on the surgical table.
2. Local anesthesia or moderate sedation is administered.
3. The surgeon uses fluoroscopic (X-ray) guidance to identify the correct level in the lumbar spine.
4. A small incision is made, and the interlaminar/interspinous device is carefully inserted between the spinous processes.
5. The device is adjusted to achieve the desired level of stabilization or distraction.
6. The incision is closed and bandaged.

Duration

The procedure typically takes between 1 to 2 hours.

Setting

This procedure is usually performed in a hospital operating room or an outpatient surgical center.

Personnel

• Orthopedic surgeon or neurosurgeon
• Surgical nurse
• Anesthesiologist or nurse anesthetist
• Radiology technician

Risks and Complications

• Infection
• Bleeding
• Allergic reaction to anesthesia or materials
• Device failure or displacement
• Nerve damage
• Persistent pain

Benefits

• Reduced lower back pain
• Improved mobility and quality of life
• Minimally invasive approach with quicker recovery compared to open surgery
• Immediate relief from nerve compression

Recovery

• Patients can typically go home the same day or the day after the procedure.
• Post-procedure instructions include keeping the incision area clean and avoiding strenuous activities.
• Medications for pain management may be prescribed.
• Full recovery might take a few weeks, with follow-up appointments to monitor progress.

Alternatives

• Conservative treatments such as physical therapy, pain medications, and spinal injections.
• Open decompression surgery or spinal fusion, which are more invasive but may be required for severe cases.
• Each alternative has its own risks and benefits, which should be discussed with the healthcare provider.

Patient Experience

During the procedure, the patient will be sedated but not fully asleep. They might feel pressure or slight discomfort. Post-procedure, temporary soreness around the incision site is common, and pain can be managed with prescribed medications. Most patients experience significant pain relief shortly after the procedure.