JLM929
Networker
codes I went with 63081, 69990-59, 22554-51, 22845,22851 x2,22585x2 63082. the provider is question 63075 C3/4 in addition to the 2nd corpectomy C4. is this going to fall into a bundling edit?? 
He is stating. The C4 hemi corpectomy was carried out on the caudal part of the VB to better address the pathological cord compression adjacent to the C4/5 level. It is not related to the C3/4 discectomy, which is at the cephaled part of C4.
I can not find any information to confirm this. thanks for any thoughts or comments in advance. Such a trying field
we proceeded to undercut the longus colli insertion using bipolar cautery. A lateral fluoroscopic shoot through with radiopaque marker confirmed the levels. Following radiographic confirmation, we picked 2 retractor blades from the Shadow-Line set of an appropriate length to facilitate with the exposure. The remainder of surgery, including all portions pertaining to corpectomy and microdissection, was carried out with the assistance of a surgical microscope. Initially, we carried out the anterior cervical discectomy at the C3-C4 level. This was done initially using a 15 blade in conjunction with variably angled micro curettes. Once we reached the level of the posterior annulus/posterior longitudinal ligament, we used a sharp hook to breach this level. The remainder of the decompression was carried out using a combination of 1 and 2 mm Kerrison punch. We were able to remove significant bone spur above and below, as well as remove the large central disc herniation with clear annular defect. Following meticulous hemostasis, we prepared the endplates for the cage by burring it with the Midas Rex drill. I found that a 8 mm x 12 mm lordotic cage fit quite nicely. The center of the hollow cage was packed with Vitoss bone filler and locally harvest bone. This was tamped gently in place under live fluoroscopic guidance. Once we were satisfied, we focused our attention on the C5 corpectomy. Once again after undercutting the insertion of the longus colli muscle, we were able to carry out the decompression at this level under Caspar pin distraction using 12 mm pins. Initially, we carried out the gross discectomies at the C4/5 and C5/6 levels using a combination of a 15 blade, as well as variably angled sharp curettes. The remainder of the discectomy was then completed using a combination of 1 and 2 mm Kerrison punch. It should be noted that at both levels, we encountered severe cord compression. The corpectomy was then completed using a combination of double-action rongeur, high-speed drill, 1 mm and 2 mm Kerrison punches. All bone harvested locally was saved to be used for the interbody fusion at the end of the case. Once we reached the level of the posterior longitudinal ligament, we breached it using a blunt hook.At both level we encountered severe central stenosis secondary large extruded disc fragment in the setting of clear annular defect. The remainder of the decompression was then completed using a combination of 1 mm and 2 mm Kerrison punches. It should be noted that significant cord compression was once again noted at both intervening levels, worse at the C4-5 level with an extension of the osteophyte complex both cephalad and caudal to the vertebral bodies of C4 and C5. It should be noted that in the course of decompression, at no point did the electrophysiological monitoring parameters deviate from baseline. In addition to the C5 corpectomy, with greater than 90% of the vertebral body resected, in order to affect adequate spinal cord decompression, we completed a hemicorpectomy of C4 with greater than 55% of the verterbral body removed. *
This was performed using a combination of the double-action rongeur, 2 and 3 mm Kerrison punches, as well as sharp curettes. All corpectomy bone was then saved to be used at the end of the case for the planned interbody fusion. Once we were satisfied with decompression, we carried out meticulous hemostasis using bipolar cautery and FloSeal foam. We burred off the endplates of C6, and picked a 24 mm lordotic PEEK cage packed with the patient's own bone to fill the decompressed level extending from the hemivertebral of C4 to C6. This bone was morselized using double-action rongeur and packed to the hollow center of the cage using micro instruments. The cage was then tamped gently in place under live fluoroscopic guidance. Once we were satisfied with the cage position, we picked a lordotic titanium plate to span the C3 down to the C6 levels. The plate was secured in place using a total of six 15-mm self drilling cortical cancellous screws. The screw purchase was deemed adequate, but suboptimal. Final AP, as well as lateral fluoroscopic shoot through demonstrated good decompression, preservation of disc space interbody height, overall anatomic alignment, as well as a satisfactory instrument placement, including the cage and the plates.
He is stating. The C4 hemi corpectomy was carried out on the caudal part of the VB to better address the pathological cord compression adjacent to the C4/5 level. It is not related to the C3/4 discectomy, which is at the cephaled part of C4.
I can not find any information to confirm this. thanks for any thoughts or comments in advance. Such a trying field
we proceeded to undercut the longus colli insertion using bipolar cautery. A lateral fluoroscopic shoot through with radiopaque marker confirmed the levels. Following radiographic confirmation, we picked 2 retractor blades from the Shadow-Line set of an appropriate length to facilitate with the exposure. The remainder of surgery, including all portions pertaining to corpectomy and microdissection, was carried out with the assistance of a surgical microscope. Initially, we carried out the anterior cervical discectomy at the C3-C4 level. This was done initially using a 15 blade in conjunction with variably angled micro curettes. Once we reached the level of the posterior annulus/posterior longitudinal ligament, we used a sharp hook to breach this level. The remainder of the decompression was carried out using a combination of 1 and 2 mm Kerrison punch. We were able to remove significant bone spur above and below, as well as remove the large central disc herniation with clear annular defect. Following meticulous hemostasis, we prepared the endplates for the cage by burring it with the Midas Rex drill. I found that a 8 mm x 12 mm lordotic cage fit quite nicely. The center of the hollow cage was packed with Vitoss bone filler and locally harvest bone. This was tamped gently in place under live fluoroscopic guidance. Once we were satisfied, we focused our attention on the C5 corpectomy. Once again after undercutting the insertion of the longus colli muscle, we were able to carry out the decompression at this level under Caspar pin distraction using 12 mm pins. Initially, we carried out the gross discectomies at the C4/5 and C5/6 levels using a combination of a 15 blade, as well as variably angled sharp curettes. The remainder of the discectomy was then completed using a combination of 1 and 2 mm Kerrison punch. It should be noted that at both levels, we encountered severe cord compression. The corpectomy was then completed using a combination of double-action rongeur, high-speed drill, 1 mm and 2 mm Kerrison punches. All bone harvested locally was saved to be used for the interbody fusion at the end of the case. Once we reached the level of the posterior longitudinal ligament, we breached it using a blunt hook.At both level we encountered severe central stenosis secondary large extruded disc fragment in the setting of clear annular defect. The remainder of the decompression was then completed using a combination of 1 mm and 2 mm Kerrison punches. It should be noted that significant cord compression was once again noted at both intervening levels, worse at the C4-5 level with an extension of the osteophyte complex both cephalad and caudal to the vertebral bodies of C4 and C5. It should be noted that in the course of decompression, at no point did the electrophysiological monitoring parameters deviate from baseline. In addition to the C5 corpectomy, with greater than 90% of the vertebral body resected, in order to affect adequate spinal cord decompression, we completed a hemicorpectomy of C4 with greater than 55% of the verterbral body removed. *
This was performed using a combination of the double-action rongeur, 2 and 3 mm Kerrison punches, as well as sharp curettes. All corpectomy bone was then saved to be used at the end of the case for the planned interbody fusion. Once we were satisfied with decompression, we carried out meticulous hemostasis using bipolar cautery and FloSeal foam. We burred off the endplates of C6, and picked a 24 mm lordotic PEEK cage packed with the patient's own bone to fill the decompressed level extending from the hemivertebral of C4 to C6. This bone was morselized using double-action rongeur and packed to the hollow center of the cage using micro instruments. The cage was then tamped gently in place under live fluoroscopic guidance. Once we were satisfied with the cage position, we picked a lordotic titanium plate to span the C3 down to the C6 levels. The plate was secured in place using a total of six 15-mm self drilling cortical cancellous screws. The screw purchase was deemed adequate, but suboptimal. Final AP, as well as lateral fluoroscopic shoot through demonstrated good decompression, preservation of disc space interbody height, overall anatomic alignment, as well as a satisfactory instrument placement, including the cage and the plates.