Wiki Spine case assistance

jamesttg09@gmail.com

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Currently, I am requesting assistance regarding the spine surgical case below. The provider CPT code selection is not in agreement with the coder. Thank you.


PREOPERATIVE DIAGNOSIS:

1. Cervical spondylosis with myelopathy.

2. Cervical stenosis.

POSTOPERATIVE DIAGNOSIS:
Same.



PROCEDURES:

1. Anterior cervical corpectomy C6.

2. ACDF C4-5.

3. Placement of a biomechanical intervertebral spacer interbody at C4-5.

4. Placement of a corpectomy vertebral body replacement implant for C6 corpectomy extending from C5 C7. Using the Hawkeye VBR implant.

5. Anterior cervical plating and instrumentation C4 C7 using the Atlantis translational plate system.





PROCEDURE IN DETAIL:

After fully informed consent was obtained patient was then taken to the operating room and underwent general endotracheal intubation. Patient was provided 1 g of Ancef prior to commencement of the procedure. Mayfield tongs were then applied to the cranium with approximately 60 pounds. Patient was then positioned on the operating table in the supine position with the Mayfield tongs apparatus. Patient was locked into place and placed in the proper position. The anterior cervical region was then prepped and draped in normal sterile fashion. A left-sided carotid incision was then made approximately 4 cm in length. Dissection was made down through the skin and

subcutaneous tissue sharply Bovie used for hemostasis. The sternocleidomastoid muscle was identified and this was retracted laterally. The trachea and esophagus were identified and retracted medially. We were then able to identify the prevertebral fascia. The fascia was taken down with a peanut dissector. A black belt retractor was then placed within the wound spinal needle was placed within the cervical spine to identify proper levels to confirm we are at the C4-5 level. After confirmation our attention was brought at the C4-5 level a subperiosteal dissection was then formed along the inferior border of C4 down to the superior border of C7. Further dissection was made out laterally underneath the longus coli muscle. A black belt retractor was then placed at the C4-5 level for both medial lateral as well as superior and inferior retraction. A 15 blade was then placed within the C4-5 disc space followed by various pituitaries curettes and rongeurs to remove most of the disc material down to the subchondral bone. Posterior longitudinal ligament was also taken down and a Kerrison rongeur was then used to remove this and to extend out laterally into the neuroforamen. After adequate decompression was achieved the endplates were vigorously rasped. A Nano Vis intervertebral spacer was passed with ostial amp and then inserted into the intervertebral space. The retractor system was then released and moved more inferiorly for corpectomy site. The longus coli was retracted

laterally so that we could identify the uncinate joints. At the C5-6 level the anterior osteophytes were removed and a 15 blade was then placed within the disc space to grossly show the bulk of the disc material and then various pituitaries curettes and rongeurs were used toremove the remainder of all disc material down to the posterior longitudinal ligament. Similarly this was done at the C6-7 level. A Caspar pin was then placed within the C5 and in the C7 vertebrae after adequate decompression to the posterior longitudinal ligament at each level

at C5 and C6 a sagittal saw was then used to make a longitudinal cut both in the parasagittal region left and right and midline. The cut was made approximately 13 mm deep. After which a large rongeur was then used to remove the bulk of the vertebral body corpectomy this was saved for placement into the cage later. Once we are able to get down to the posterior aspect of the C C6 vertebrae a high-speed bur was then used to thin out the bone then with the use of Kerrison rongeurs a complete and total corpectomy was then done the central portion of the C6 vertebrae additionally patient had notable disc osteophytes particularly in the bilateral neuroforaminal regions at C5-6 particularly so attention was brought to these levels and foraminotomie was also performed at C5-6 bilaterally. The endplates at C5 and C7 were vigorously rasped to get good punctate bleeding within the endplates. The use of a Hawkeye vertebral body replacement implant was measured with a trial followed by determining the proper corpectomy cage placed in this region. After determining the proper cage height the cage was then filled with the local corpectomy bone and osteo amp. The cage was then impacted into the intervertebral space

between the C5 and C7 vertebrae. The Caspar pins were then removed from the traction and compression was applied. The Caspar pins were then removed. An anterior cervical plate using the Atlantis translational plate was then fashion across anterior cervical spine extending from C4 C7. After all screws were placed and intraoperative fluoroscopic image obtained and all hardware was found to be in good position. The wound was then vigorously irrigated with normal saline. A small 1/2 cm incision was made over the left clavicle and a JP drain was then placed within the wound and tunneled out through the incision. The drain was sutured in place. The wound was then closed with a running 2-0 Vicryl followed by 3-0 Monocryl and Dermabond for skin. A dry sterile dressing was placed atop

the drain site. A rigid collar was applied. Patient was then extubated Mayfield tongs were removed and patient was then transported to the recovery room in stable condition.
 
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