Corpectomy Help - Intraoperative fluoroscopy


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Can anyone help me w/the codes on this. Not sure if I can use the 22551 w/the 63081 or just the add level code.

1. Anterior cervical diskectomy C4-5, and C5-6, C5 corpectomy for decompression of spinal cord and nerve roots.
2. Anterior cervical arthrodesis with 22mm PEEK cage filled with same incision bone graft C4-C6.
3. Anterior cervical plating plating from C4-5.
4. Microscopic dissection.
5. Intraoperative fluoroscopy.

DETAILS OF PROCEDURE: The patient received preoperative antibiotics with Ancef 2g. She was brought to the operating room. Sequential compression boots were placed on the patient's legs. General endotracheal anesthesia was induced with anesthesia keeping the neck neutral during intubation. All pressure points were adequately padded and the patient was secured to the operation table. A roll was placed under the shoulders to provide mild extension of the neck. The neck was cleansed with alcohol and a transverse incision was planned on the right side of the neck for exposure of the C4-5 and C5-6 disks. Fluoroscopy was brought in and confirmed localization of the incision for these disks. The operative field was then prepped and draped in the usual sterile fashion.

The incision was made with the 15-blade knife through the skin and dermis. Using Bovie electrocautery, I dissected through the platysma muscle. The sternocleidomastoid muscle was identified and the loose connective tissue overlying this was sharply dissected. I then dissected bluntly along the medial border of the sternocleidomastoid muscle down to the anterior surface of the spine. Cloward retractor was inserted to retract the esophagus and trachea medially while the carotid remained lateral. Sharp dissection was used over the loose connective tissue on the anterior surface of the spine until the anterior surface of the spine was completely visible. A needle was then inserted in the top most disk and the lateral fluoroscopy was obtained showing this to be the C4-5 disk. I then marked this disk as well as the disk below this, marking the C4-5 and C5-6 disks. Using Bovie electrocautery, I then elevated the longus colli muscle bilaterally. The Caspar retractor blades were then inserted medially and laterally and superiorly and inferiorly. The anterior longitudinal ligament was bovied off the anterior surface of the spine from the inferior aspect of C4 down to the superior aspect of C6. There was significant anterior spurring especially at C5-6 and this was rongeured away at both levels. The microscope was then brought in for the purposed of microscopic dissection. I then used the Midas-Rex drill bit to drill away the disk and the overhanging bone spurs on the endplates of C5 and C6. Once this was completed, I was able to use a nerve hook and slip underneath the posterior longitudinal ligament and create an opening through the ligament. A 2mm punch was then used to punch away the ligament its entirety from the right foramen to the left foramen. Both foramina were well decompressed. I then moved up to the C4-5 disk where the same procedure was used. Again the disk and bony spurs were drilled away down to the posterior longitudinal ligament and this was then completely punched away and both foramina were well decompressed. Following this, the C5 vertebral body was rongeured away and bone was saved for grafting. The remainder of the C5 vertebral body and posterior longitudinal ligament which was thickened and quite compressive was punched away with kerrison punch. Once the corpectomy was completed, I was able to palpate superiorly and inferiorly underneath the endplates and they felt well decompressed and palpate with the nerve hook out both foramina at both levels and they were all well decompressed. I finished drilling the endplates of C4 and C6 until bleeding subchondral bone was visualized. Hemostasis was achieved with floseal and then irrigated well.

At this point, the wound was copiously irrigated with antibiotic solution. Anesthesia performed mild cervical traction, and the space was measured at 22mm. A PEEK stackable cage was then prepared and same incision autograft was packed in the cage. The cage was then tapped in while Anesthesia performed mild cervical traction. The graft was positioned well as directly visualized and confirmed by fluoro. I then removed the microscope. A Spine plate was then placed on the anterior surface of the spine. This fit appropriately. 14mm screws were placed after using an hand drill and guide under fluoro guidance into the C4 and C6 vertebral bodies with appropriate angulation. All screws were placed and checked with lateral fluoroscopy and confirmed to be in good position. The screws were then tightened down fully. Final lateral and AP fluoroscopy were obtained and confirmed the plate, screws and grafts to be in good position. The fluoroscopy was then removed.