kimmcelderry@gmail.com
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The physician describes a Posterior Pedicle Subtraction osteotomy at C7. Also, extracavitary fusion C6-T1. I only see codes for 3 column osteotomies as thoracic or lumbar, same for the extracavitary fusion. Any suggestions?
"After the instrumentation, I started C7 pedicle subtraction osteotomy to correct cervicothoracic kyphosis. Midline laminectomy at C6 and C7 were performed first, using variable sized osteotomes and Leksell rongeurs. We started from the right side first. Then the fused C6/7 and C7/T1 facet resected using 2-mm and 3-mm Kerrison rongeurs. After complete facetectomy, complete decompression of bilateral C6/7 and C7/T1 foramina was performed with hemostasis of the epidural space. The epidural and foraminal scar tissue was dissected under the microscope. The I removed the transverse process, transverse tubercle and transverse foramen of C7 and exposed the lateral wall of the C7 pedicle. Then I took about C7 pedicle using a high speed burr and osteotomes protecting the dural sac with a Woodson dissector. Then I removed the C7 vertebral body with a wedge-shape including the lateral wall of the vertebral body using curettes and osteotomes. I performed decancellation using a curved curette to make a void for the three-column osteotomy. After completion of the Rt side, we placed a temporary rod from C5 to T2. Then we performed a PSO with similar fashion on the Lt side.Then we placed morselized autologous bone graft for extracavitary fusionfrom C6 to T1."
He submitted:
1. Posterior pedicle subtraction osteotomy C7, C6-T1 extracavitary fusion
2. Revision instrumentation C2-T5 and fusion using local bone
(22206, 22532, 69990, 22844, 22804, 20930, 20936)
"After the instrumentation, I started C7 pedicle subtraction osteotomy to correct cervicothoracic kyphosis. Midline laminectomy at C6 and C7 were performed first, using variable sized osteotomes and Leksell rongeurs. We started from the right side first. Then the fused C6/7 and C7/T1 facet resected using 2-mm and 3-mm Kerrison rongeurs. After complete facetectomy, complete decompression of bilateral C6/7 and C7/T1 foramina was performed with hemostasis of the epidural space. The epidural and foraminal scar tissue was dissected under the microscope. The I removed the transverse process, transverse tubercle and transverse foramen of C7 and exposed the lateral wall of the C7 pedicle. Then I took about C7 pedicle using a high speed burr and osteotomes protecting the dural sac with a Woodson dissector. Then I removed the C7 vertebral body with a wedge-shape including the lateral wall of the vertebral body using curettes and osteotomes. I performed decancellation using a curved curette to make a void for the three-column osteotomy. After completion of the Rt side, we placed a temporary rod from C5 to T2. Then we performed a PSO with similar fashion on the Lt side.Then we placed morselized autologous bone graft for extracavitary fusionfrom C6 to T1."
He submitted:
1. Posterior pedicle subtraction osteotomy C7, C6-T1 extracavitary fusion
2. Revision instrumentation C2-T5 and fusion using local bone
(22206, 22532, 69990, 22844, 22804, 20930, 20936)