Transpedicular approach with decompression of spinal cord, equina and/or nerve root(s) (eg, herniated intervertebral disc), single segment; each additional segment, thoracic or lumbar (List separately in addition to code for primary procedure)
CPT4 code
Name of the Procedure:
Transpedicular approach with decompression of spinal cord, cauda equina, and/or nerve root(s) (e.g., herniated intervertebral disc), single segment; each additional segment, thoracic or lumbar
Summary
This surgical procedure involves accessing the spinal canal through the pedicles of the vertebrae to relieve pressure on the spinal cord, cauda equina, or nerve roots caused by conditions like a herniated disc. It may be performed on one or more segments of the thoracic or lumbar spine. The additional segments are treated in addition to the primary procedure.
Purpose
Medical Condition or Problem Addressed:
This procedure addresses conditions where there is compression of the spinal cord, cauda equina, or nerve roots, often due to herniated intervertebral discs or spinal stenosis.
Goals or Expected Outcomes:
- Relieve pressure on neural elements to alleviate pain, numbness, or weakness.
- Restore function and mobility.
- Prevent further neurological damage.
Indications
Specific Symptoms or Conditions:
- Severe back or leg pain not relieved by conservative treatments.
- Muscle weakness or loss of function in the legs.
- Numbness or tingling in the legs.
- Bladder or bowel dysfunction in severe cases.
Patient Criteria:
- Confirmed diagnosis of spinal cord or nerve root compression through imaging studies like MRI or CT scans.
- Failure of non-surgical treatments such as physical therapy, medications, or injections.
Preparation
Pre-procedure Instructions:
- Fasting typically required starting midnight before the procedure.
Potentially discontinuing certain medications like blood thinners, as advised by the doctor.
Diagnostic Tests:
- Imaging studies (MRI, CT scans).
- Blood tests.
- Pre-anesthetic evaluation.
Procedure Description
Step-by-Step Explanation:
- Anesthesia: The patient is given general anesthesia.
- Incision: A small incision is made over the affected segment of the spine.
- Exposure: Muscles and tissues are moved to expose the vertebrae.
- Access: A burr is used to create a pathway through the pedicles to access the spinal canal.
- Decompression: The surgeon removes portions of the herniated disc or other structures compressing the spinal cord or nerve roots.
- Closure: The instruments are removed, and the incision is closed with sutures or staples.
Tools and Technology:
- Surgical burr and rongeurs.
- Imaging guidance tools like fluoroscopy.
- Surgical microscope, if needed.
Anesthesia:
General anesthesia is typically used to ensure the patient is fully asleep and pain-free.
Duration
The procedure usually takes between 2 to 4 hours, depending on the number of segments involved.
Setting
Performed in a hospital operating room or specialized surgical center.
Personnel
- Orthopedic spine surgeon or neurosurgeon.
- Anesthesiologist.
- Surgical nurses and technicians.
Risks and Complications
Common Risks:
- Infection.
- Bleeding.
- Pain at the incision site.
Rare Risks:
- Nerve damage.
- Spinal fluid leak.
- Anesthesia-related complications.
Possible Complications:
- Temporary or permanent neurological deficits.
- Recurrence of symptoms.
Benefits
- Significant pain relief.
- Improved mobility and function.
- Prevention of further neurological damage.
Realization of Benefits:
Benefits are typically noticeable within weeks, though full recovery can take several months.
Recovery
Post-procedure Care:
- Hospital stay for a few days.
- Pain management with medications.
- Gradual increase in activity levels as advised by the doctor.
Expected Recovery Time:
- 6 to 12 weeks for most patients.
- Physical therapy may be recommended.
Restrictions and Follow-up:
- Avoid lifting heavy objects.
- Follow-up appointments for wound check and recovery assessment.
Alternatives
Other Treatment Options:
- Conservative treatments (physical therapy, medications, injections).
- Other surgical options like discectomy or laminectomy.
Pros and Cons of Alternatives:
- Conservative treatments have fewer risks but may not be effective for severe cases.
- Other surgical options vary in invasiveness and recovery time.
Patient Experience
During the Procedure:
- The patient is under general anesthesia and will not feel anything.
After the Procedure:
- Some pain and discomfort at the incision site.
- Pain management strategies include medications and possibly ice packs.
- Gradual improvement in symptoms over time.
Pain management is typically effective, and the healthcare team will take measures to ensure patient comfort throughout the recovery process.