CCANTER
Networker
can someone review this op note and do they see documentation for an L4-L5 pseudarthrosis repair CPT code 22614? I only see fusion at the L3-L4 level CPT code 22612.
The patient was then flipped over prone on the OSI Jackson table, which was appropriately sized on the patient's torso. Patient was padded and both the chest and anterior iliac crest and thighs. Axillae were free bilaterally. Elbows and knees were padded appropriately. LS spine was then prepped and draped in the usual sterile manner. Previous incision was excised back to new ridges and extended slightly to go to the L3 level, and then this was carried down to the deep fascia, then down to the hardware bilaterally. We had the proprietary instrumentation to remove this hardware at the L4 left position, and then otherwise removed the rods and all the set screws. We then extended with placement of pedicle screws bilaterally with our standard anatomical entry points at L3. Individual screws were tested with EMG signal processing, and no problems noted.
We then went with a longer 7.5 mm screw to span the fracture site at L4. I had my SSEP monitoring tech watching for any EMG activity, and then of course testing that screw again and to make sure that there was not a fracture breach, which would continue to irritate the nerve root. This was not the case. We had good fixation across there and spanned, of course, up to L3. Rods were dropped into position, cut, and contoured down, tightened both facet screws, and then placed our bone graft over the decorticated surfaces from the L3 transverse process down to the fusion mass and transverse process of L4. The wound was then irrigated out prior to doing all the bone grafting with 1000 mL of 0.3% povidone solution in 1000 mL saline solution, and once the bone graft was placed, we the deep fascia with a running #1 Vicryl stitch, followed by 1000 mL antibiotic-laden pulse lavage, followed by placement of vancomycin powder 1 gram.
The patient was then flipped over prone on the OSI Jackson table, which was appropriately sized on the patient's torso. Patient was padded and both the chest and anterior iliac crest and thighs. Axillae were free bilaterally. Elbows and knees were padded appropriately. LS spine was then prepped and draped in the usual sterile manner. Previous incision was excised back to new ridges and extended slightly to go to the L3 level, and then this was carried down to the deep fascia, then down to the hardware bilaterally. We had the proprietary instrumentation to remove this hardware at the L4 left position, and then otherwise removed the rods and all the set screws. We then extended with placement of pedicle screws bilaterally with our standard anatomical entry points at L3. Individual screws were tested with EMG signal processing, and no problems noted.
We then went with a longer 7.5 mm screw to span the fracture site at L4. I had my SSEP monitoring tech watching for any EMG activity, and then of course testing that screw again and to make sure that there was not a fracture breach, which would continue to irritate the nerve root. This was not the case. We had good fixation across there and spanned, of course, up to L3. Rods were dropped into position, cut, and contoured down, tightened both facet screws, and then placed our bone graft over the decorticated surfaces from the L3 transverse process down to the fusion mass and transverse process of L4. The wound was then irrigated out prior to doing all the bone grafting with 1000 mL of 0.3% povidone solution in 1000 mL saline solution, and once the bone graft was placed, we the deep fascia with a running #1 Vicryl stitch, followed by 1000 mL antibiotic-laden pulse lavage, followed by placement of vancomycin powder 1 gram.
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