sdunaway1
Guru
Can you code a percutaneous approach for a cervical arthrodesis as 22600,22614 as you would an open approach? I cannot find a cpt code for this approach.
The patient was then turned gently prone onto a regular OR table with gel rolls supporting the shoulders and hips. Her head was placed in a soft prone view cushion. The table was turned approximately 45 degrees from anesthesia. Biplanar C-arm fluoroscopy was then brought into the field and the cervical spine was imaged and the AP and lateral planes to identify the spinous processes along with the medial and lateral borders of the facet joints. These were marked out on the skin.
The area was then prepped and draped in the standard surgical manner. I then began the operation by inserting a spinal needle under fluoroscopic guidance in the right paraspinous musculature and a trajectory aimed at the midpoint of the facet at C6-C7. Once a satisfactory starting point was obtained the skin incision was then made with a #11 blade. I then used the CAVUX percutaneous soft tissue dilation system to dock at the right C6-C7 facet joint. The system was then used to decorticate and prepare the facet joint for fusion. After appropriate preparation a 4 mm X cage was packed with 1 cc of Globus via cell allograft and malleted into the C6-C7 facet joint under fluoroscopic guidance. The cage was backfilled with 1/2 cc of allograft and the docking system was then removed. The same sequence was then carried out on the patient's left side at C6-C7 under fluoroscopic guidance. Again the facet joint was decorticated and prepared for fusion. A second 4 mm X cage was packed with 1 cc of Globus ViaCell allograft and malleted into the left C6-C7 facet joint under fluoroscopic guidance. 2 Ally Bone screws were then used to anchor the cage into the facet joint at C6-C7. The cage was subsequently backfilled with another half cc of allograft to affect the posterior arthrodesis at C6-C7.
Again under fluoroscopic guidance the soft tissue dilation system was used to dock at the C5 and C6 facet joint on the patient's left side. Once more this facet joint was decorticated and prepared for fusion. Once this was done a third 4 mm cage was packed with the same contents as above and malleted into the C5-C6 facet joint on the left side under fluoroscopic guidance. 2 more bone screws were then used to anchor the cage and the facet joint. 1/2 cc of allograft was used to backfill the cage as the soft tissue dilation system was then removed. I then moved back to the patient's right side where the C5-C6 facet joint on this side was then accessed with the docking system under fluoroscopic guidance. The facet joint at C5-C6 was then decorticated and prepared for fusion utilizing the CAVUX system. Once the facet joint was prepared for fusion a four 4 mm cage was packed with allograft and malleted into the C5-C6 facet on the right side under fluoroscopic guidance. Again this cage was anchored in the facet joint with 2 bone screws and the cage was backfilled with allograft. The soft tissue dilation system was removed. This concluded the posterior arthrodesis at C5-C6 along with the posterior nonsegmental instrumentation from C5-6 to C6-7.
thank you
The patient was then turned gently prone onto a regular OR table with gel rolls supporting the shoulders and hips. Her head was placed in a soft prone view cushion. The table was turned approximately 45 degrees from anesthesia. Biplanar C-arm fluoroscopy was then brought into the field and the cervical spine was imaged and the AP and lateral planes to identify the spinous processes along with the medial and lateral borders of the facet joints. These were marked out on the skin.
The area was then prepped and draped in the standard surgical manner. I then began the operation by inserting a spinal needle under fluoroscopic guidance in the right paraspinous musculature and a trajectory aimed at the midpoint of the facet at C6-C7. Once a satisfactory starting point was obtained the skin incision was then made with a #11 blade. I then used the CAVUX percutaneous soft tissue dilation system to dock at the right C6-C7 facet joint. The system was then used to decorticate and prepare the facet joint for fusion. After appropriate preparation a 4 mm X cage was packed with 1 cc of Globus via cell allograft and malleted into the C6-C7 facet joint under fluoroscopic guidance. The cage was backfilled with 1/2 cc of allograft and the docking system was then removed. The same sequence was then carried out on the patient's left side at C6-C7 under fluoroscopic guidance. Again the facet joint was decorticated and prepared for fusion. A second 4 mm X cage was packed with 1 cc of Globus ViaCell allograft and malleted into the left C6-C7 facet joint under fluoroscopic guidance. 2 Ally Bone screws were then used to anchor the cage into the facet joint at C6-C7. The cage was subsequently backfilled with another half cc of allograft to affect the posterior arthrodesis at C6-C7.
Again under fluoroscopic guidance the soft tissue dilation system was used to dock at the C5 and C6 facet joint on the patient's left side. Once more this facet joint was decorticated and prepared for fusion. Once this was done a third 4 mm cage was packed with the same contents as above and malleted into the C5-C6 facet joint on the left side under fluoroscopic guidance. 2 more bone screws were then used to anchor the cage and the facet joint. 1/2 cc of allograft was used to backfill the cage as the soft tissue dilation system was then removed. I then moved back to the patient's right side where the C5-C6 facet joint on this side was then accessed with the docking system under fluoroscopic guidance. The facet joint at C5-C6 was then decorticated and prepared for fusion utilizing the CAVUX system. Once the facet joint was prepared for fusion a four 4 mm cage was packed with allograft and malleted into the C5-C6 facet on the right side under fluoroscopic guidance. Again this cage was anchored in the facet joint with 2 bone screws and the cage was backfilled with allograft. The soft tissue dilation system was removed. This concluded the posterior arthrodesis at C5-C6 along with the posterior nonsegmental instrumentation from C5-6 to C6-7.
thank you