NESmith
Expert
I have looked at this for so long, i have totally confused myself.
Pre & Postoperative dx; 1)Thoracic disk herniation
2)Thoracic spondylosis
3)Thoracic myelopathy
Description of Procedure:Gardner-Well tongs were applied to the head and she was turned prone on the Jackson table where all bony prominences were padded. Neurologic structures were protected and 15 lbs of weight were applied to the head affecting cranial traction. A timeout was called confirming correct patient, correct procedure, that all necessary devices were available and prophylactic antibiotics had been administered. We then sterilely prepped and draped her in standard fashion and incision was localized over the T10 spinous process. Dissection was carried out down to the tips of the transverse processes from T7-T11. following this, we resected the spinous process from the caudal half of T7 to the cranial half of T11, taking care to maintain the supra and interspinous ligaments between T6-T7 and T11-T12.
We performed bilateral inferior facetectomies/posterior osteotomies from T10-T7 in order to obtain autograft bone, expose bony landmarks for screw placement and allow for removal of articular cartilage to promote ultimate fusion.
We performed a wide midline laminectomy at T10-T11 and found bony overgrowth beneath the facet joints of the T10-T11 resulting in severe stenosis. this was drilled down upon and allowed to flow away from the spinal cord, no dural erosions were present. We then performed foraminotomies bilaterally at T10-T11. This level was then felt to be completely decompressed. We then performed a midline laminectomy at T8-T9.
We then performed a left-sided Smith-Petersen osteotomy and took out the entire facet joint on the right side. The laminectomy was extended cranially and caudally along the medical borders of the T8-T9 pedicles on the left side and the spinal cord was elevated. A Woodson elevator was utilized to feel beneath the spinal cord. Disk herniation was readily palpable. After numerous careful attempts at removal of the disk herniation, the Woodson was then stuck into the surrounding scar tissue and I was able to express the nucleus pulposus material within the extruded fragment. Once this was complete, the left of the midline mass was felt to have been significantly decreased to nearly flat. There was no residual pressure on the spinal cord either dorsally or ventrally. following this, we placed pedicle screws utilizing anatomic landmarks. All screws were placed without difficulty and their position was confirmed with fluoroscopy as well as with pedicle stimulation. Following this, we measured, cut and contoured rods and reduced the spine to the rods. Intraoperative AP and lateral radiographs were obtained which showed acceptable placement of all implants and positioning of the spine.
Following this, we irrigated the wound with copious amounts of antibiotic-laden sterile saline through a pulse lavage. The residual posterior bony elements were decorticated and autograft, allograft and BMP were placed after Evicel and Duragen were placed over the exposed dura. A crosslink was applied. Deep frain was placed and the wound was closed in layers.
The patient awoke without event and was taken to the recovery room in stable condition.
The provider has coded this procedure;63016,63055,22842,22610,22614, 22212,22216,20936,20661 & 20665.
Dx: 724.01 & 722.72.
I do not feel this is correct but after looking at it for so long, now I am not sure. Please help and as always Thank You so much.
Pre & Postoperative dx; 1)Thoracic disk herniation
2)Thoracic spondylosis
3)Thoracic myelopathy
Description of Procedure:Gardner-Well tongs were applied to the head and she was turned prone on the Jackson table where all bony prominences were padded. Neurologic structures were protected and 15 lbs of weight were applied to the head affecting cranial traction. A timeout was called confirming correct patient, correct procedure, that all necessary devices were available and prophylactic antibiotics had been administered. We then sterilely prepped and draped her in standard fashion and incision was localized over the T10 spinous process. Dissection was carried out down to the tips of the transverse processes from T7-T11. following this, we resected the spinous process from the caudal half of T7 to the cranial half of T11, taking care to maintain the supra and interspinous ligaments between T6-T7 and T11-T12.
We performed bilateral inferior facetectomies/posterior osteotomies from T10-T7 in order to obtain autograft bone, expose bony landmarks for screw placement and allow for removal of articular cartilage to promote ultimate fusion.
We performed a wide midline laminectomy at T10-T11 and found bony overgrowth beneath the facet joints of the T10-T11 resulting in severe stenosis. this was drilled down upon and allowed to flow away from the spinal cord, no dural erosions were present. We then performed foraminotomies bilaterally at T10-T11. This level was then felt to be completely decompressed. We then performed a midline laminectomy at T8-T9.
We then performed a left-sided Smith-Petersen osteotomy and took out the entire facet joint on the right side. The laminectomy was extended cranially and caudally along the medical borders of the T8-T9 pedicles on the left side and the spinal cord was elevated. A Woodson elevator was utilized to feel beneath the spinal cord. Disk herniation was readily palpable. After numerous careful attempts at removal of the disk herniation, the Woodson was then stuck into the surrounding scar tissue and I was able to express the nucleus pulposus material within the extruded fragment. Once this was complete, the left of the midline mass was felt to have been significantly decreased to nearly flat. There was no residual pressure on the spinal cord either dorsally or ventrally. following this, we placed pedicle screws utilizing anatomic landmarks. All screws were placed without difficulty and their position was confirmed with fluoroscopy as well as with pedicle stimulation. Following this, we measured, cut and contoured rods and reduced the spine to the rods. Intraoperative AP and lateral radiographs were obtained which showed acceptable placement of all implants and positioning of the spine.
Following this, we irrigated the wound with copious amounts of antibiotic-laden sterile saline through a pulse lavage. The residual posterior bony elements were decorticated and autograft, allograft and BMP were placed after Evicel and Duragen were placed over the exposed dura. A crosslink was applied. Deep frain was placed and the wound was closed in layers.
The patient awoke without event and was taken to the recovery room in stable condition.
The provider has coded this procedure;63016,63055,22842,22610,22614, 22212,22216,20936,20661 & 20665.
Dx: 724.01 & 722.72.
I do not feel this is correct but after looking at it for so long, now I am not sure. Please help and as always Thank You so much.