Costovertebral approach with decompression of spinal cord or nerve root(s) (eg, herniated intervertebral disc), thoracic; each additional segment (List separately in addition to code for primary procedure)
CPT4 code
Name of the Procedure:
Costovertebral Approach with Decompression of Spinal Cord or Nerve Root(s) (e.g., herniated intervertebral disc), thoracic; each additional segment
Summary
This procedure involves accessing the thoracic spine through the costovertebral (rib and spine) area to perform decompression of the spinal cord or nerve roots. It is often utilized to treat conditions such as herniated discs, which can compress the spinal nerves or cord.
Purpose
This procedure addresses spinal conditions like herniated discs that cause nerve compression. The goal is to relieve pressure on the spinal cord or nerve roots, thereby alleviating pain, numbness, or weakness in the affected areas.
Indications
Symptoms warranting this procedure include persistent thoracic back pain, numbness, weakness, or radiating pain unresponsive to conservative treatments. It may be suitable for patients with imaging studies indicating nerve or cord compression.
Preparation
Patients are usually instructed to fast for a designated period before surgery, and certain medications may need to be adjusted. Preoperative assessments often include imaging studies like MRI or CT scans and general health evaluations to ensure the patient is fit for surgery.
Procedure Description
- The patient is placed under general anesthesia.
- An incision is made near the costovertebral junction of the spine.
- Muscles and tissues are carefully retracted to expose the thoracic spine.
- Specialized surgical tools are used to remove part of the vertebrae or intervertebral disc causing compression.
- Decompression is ensured by visualizing the spinal cord or nerve roots.
- The incision is closed in layers, and sterile dressings are applied.
Duration
The procedure typically takes 2 to 4 hours, depending on the number of segments being decompressed.
Setting
The procedure is performed in a hospital or specialized surgical center equipped with the necessary facilities for spine surgery.
Personnel
The surgical team usually includes a spine surgeon, anesthesiologist, surgical nurses, and possibly a neurophysiologist for intraoperative monitoring.
Risks and Complications
Potential risks include infection, bleeding, spinal fluid leakage, nerve damage, and anesthesia-related complications. Rarely, there may be complications like blood clots or incomplete relief of symptoms.
Benefits
The expected benefits include relief from pain, improved mobility, and decreased neurological symptoms. Patients may notice these improvements within days to weeks following surgery.
Recovery
Postoperative care involves pain management, wound care, and gradual activity resumption. Patients may need physical therapy and follow-up visits to monitor recovery. Full recovery might take several weeks to months.
Alternatives
Other treatment options include conservative management with medications, physical therapy, or less invasive procedures like steroid injections. Surgical alternatives might involve different approaches depending on the specific spinal pathology.
Patient Experience
During the procedure, patients will be under anesthesia and won't feel pain. Postoperatively, pain management includes medications and possibly a brief hospital stay. Patients can expect some discomfort and limited mobility initially, with gradual improvement over time.