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Spine Surgery

Nicole Posted Mon 24th of September, 2012 21:41:23 PM

need ICD 9 procedures codes for this surgery please.
OPERATION: Posterolateral fusion L4-5 with segmental pedicle screw instrumentation Alphatec Zodiac screw and rod construct with L3-5 instrumentation secondary to incompetent right L4 pedicle screw; autologous iliac crest bone graft harvested via separate fascial incision left posterior iliac crest; intraoperative SSEP/EMG monitoring; intraoperative fluoroscopic imaging.

OPERATIVE DESCRIPTION: The patient was brought to the operating room, at which time general anesthesia was administered and endotracheal intubation was achieved. She was flipped over prone on the OSI Jackson table after a Foley catheter had been placed in the urinary bladder and the appropriate leads placed for SSEP/EMG monitoring. The OSI Jackson table was the appropriate size and length for the patient’s torso with pads at the breast, bilateral os at anterior
iliac crest, and thigh. Axillae were free bilaterally. Elbows and knees were padded appropriately. LS spine was then prepped and draped in the usual sterile manner. We did not have to extend her
incision because the L3-4 level was included in the previous scar. This was excised xxxxxxx using a #10 scalpel blade and was carried down to the level of deep fascia with hemostasis being
maintained throughout with the cautery device. At his point, a subperiosteal dissection was carried out from the palpable L3 spinous process down to the L3 facet joint complex. Great care was
taken to maintain the integrity of the L2-3 facet capsule, which looked pristine. The L3-4 capsule was isolated by the hardware. The hardware was removed to L4-5 with an M8 Medtronics system
and the instrumentation was available to remove this. This was confirmed and we have a solid fusion at the L4-5 level and attention was turned up to our level. We placed pedicle screws at L3
bilaterally using the anatomical markers, that being the confluence of the lateral aspect of the pars interarticularis of the inferior border of the transverse process. These areas were drilled out with
a 4-mm round-tipped burr and then a 5.5 mm tap after advancing with a blunt-tipped sound. The tapped areas were then explored and then appropriate screws placed. There was no breech noted of the medial pedicle wall or into the medial pedicle wall. At L4, an attempt was made to place an L4 pedicle screw through a newer entry point, which was farther lateral in, this being the confluence of the lateral aspect of the pars interarticularis with the inferior border of transverse process not where the screw had been removed from, which was directly into the facet joint and much more medial. This, however, only gave a xxxxxxx of 5 milliamps on SSEP/EMG signal
process when palpated with the probe indicating that there was incompetence inferomedial to medial wall of the pedicle. We, therefore, elected to not place a screw there, but went down to L5
where there was very good fixation with a salvage screw of 11.5 mm diameter. This was done on the left side, as well, at L3 and L5. A bone graft was harvested via xxxxxxx from the left posterior
iliac crest xxxxxxx , both cortical and cancellus bone was harvested and placed over the severely decorticated surface of the transverse process at L3 at the lateral aspect of the pars interarticularis
and remnants of the L4-5 joints on both sides and then irrigated out. The area of bone graft harvest was thoroughly irrigated out and packed off with xxxxxxx and soaked in 0.5% Marcaine with
epinephrine and one soaked in antibiotic solution and closed with a running number 1 Vicryl stitch
to the area.

SuperCoder Answered Tue 25th of September, 2012 23:47:16 PM


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