63301 Vertebral corpectomy (vertebral body resection), partial or complete, for excision of intraspinal lesion, single segment; extradural, thoracic by transthoracic approach

Name of the Procedure:

Vertebral Corpectomy (Vertebral Body Resection), Partial or Complete, for Excision of Intraspinal Lesion, Single Segment; Extradural, Thoracic by Transthoracic Approach

Summary

A vertebral corpectomy is a surgical procedure aimed at removing part or all of the vertebral body to excise an intraspinal lesion located outside the dura mater. This specific approach is done through the chest (transthoracic) to access the thoracic region of the spine.

Purpose

The procedure is used to treat lesions within the spine that can cause significant symptoms or functional impairment. The goals are to relieve pressure on the spinal cord or nerves, stabilize the spine, and remove pathological tissues causing symptoms.

Indications

• Persistent pain unresponsive to conservative treatments
• Neurological deficits or spinal cord compression
• Intraspinal tumors or lesions (e.g., metastatic cancers, benign tumors)
• Spinal infections or abscesses not responding to antibiotics

Preparation

• Fasting for at least 8 hours prior to surgery
• Medication adjustments, particularly for blood thinners
• Preoperative imaging (MRI, CT scans)
• Blood tests and possibly pulmonary function testing

Procedure Description

1. General anesthesia is administered.
2. The patient is positioned on their side (lateral decubitus) or back (supine).
3. An incision is made along the side of the chest to access the thoracic spine.
4. Ribs and underlying tissues are carefully moved aside to expose the vertebral body.
5. The targeted vertebral body is partially or fully removed to reach and excise the intraspinal lesion.
6. If necessary, spinal stabilization with instrumentation (rods, screws) is performed.
7. The surgical site is closed with sutures or staples, and a chest tube may be placed to aid recovery.

Duration

The procedure typically takes 4 to 6 hours, depending on the complexity and extent of the lesion.

Setting

Performed in a hospital setting within an operating room.

Personnel

• Neurosurgeon or orthopedic spine surgeon
• Surgical assistants
• Anesthesiologist
• Operating room nurses
• Post-operative care team

Risks and Complications

• Common risks: infection, bleeding, pain at the surgical site, difficulty breathing.
• Rare risks: spinal cord injury, neurological deficits, hardware failure, pneumonia.

Benefits

• Relief from pain and neurological symptoms
• Removal of pathological tissues causing the problem
• Stabilization of the spine, leading to improved mobility

Recovery

• Hospital stay of about 5 to 7 days
• Pain management through medication
• Gradual resumption of normal activities over several weeks
• Follow-up appointments for wound care, imaging, and physical therapy

Alternatives

• Non-surgical treatments: physical therapy, pain management, medication.
• Minimally invasive spinal surgeries: laminectomy, discectomy.
• Conservative management with close monitoring.

Patient Experience

During the procedure, the patient is under general anesthesia and feels no pain. Postoperatively, there may be discomfort at the incision site and potential breathing challenges, which are managed with pain medications and supportive care. Full recovery and return to normal activities typically take several weeks.