your thoughts, opinions and/or suggestions??

JLM929

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what codes would you code on this op? thanks in advance for all the comments or suggestions.


The patient was brought to the operating room and transferred onto the OR table. The patient was induced with general anesthesia/TIVA, and intubation performed with no neck manipulation using the Glidescope.
Care was taken to insure that all pressure points were padded and the neck was in a neutral position. The patient's cervical collar was removed. AP and lateral fluoroscopy were used to check cervical alignment and to plan an appropriate trajectory to the C6-7 level. Based on lateral fluoroscopy, an incision was planned the medial to the left sternocleidomastoid muscle. The skin was then prepped and draped in usual sterile fashion.
A full surgical timeout was undertaken identifying the site, side and level(s) of surgery. The patient received preoperative antibiotics. Baseline collection physiological monitoring was obtained. 10 mg of Decadron were administered and MAPs were kept > 85 mmHg. The planned incision was infiltrated 1% lidocaine with 100,000 of epinephrine.
A #15 blade was used to incise the skin. Monopolar cautery was used to dissect down and through the platysma. The platysma was undermined with monopolar cautery. A combination of bipolar cautery, Metzenbaum scissors and blunt dissection was used to further expose at the medial border of the sternocleidomastoid muscle. I could then palpate the carotid artery and swept medially to identify the anterior cervical spine. With hand-held retractors in place, the prevertebral fascia was identified, cauterized with bipolar cautery and incised with Metzenbaum scissors. This plane was further developed with combination of blunt and sharp dissection. There was considerable hematoma infiltrated in the prevertebral fascia.
A bent spinal needle was placed at the disc space of the appropriate surgical level which was also confirmed on lateral fluoroscopy and with radiology. The disc had been completely disrupted by the patient's trauma, with complete rupture of the ALL. The longus coli and anterior vertebral bodies were exposed and the longus coli muscles undermined with monopolar cautery. The shadow line retraction system was then applied.
Caspar distraction pins were placed at C6 and C7, and then the disc space was distracted open. Pituitary rongeur and curettes were used to remove disc material. Sequential cornerstone burs were used to remove further disc material and prepare the endplates. A matchstick bur was used to remove posterior osteophytes. The posterior longitudinal ligament was disrupted by the trauma, and ventral epidural hematoma evacuated. The dura was visualized. Following decompression, a nerve hook could be passed along the ventral surface of the thecal sac into both foramina without any difficulty. Electrical physiological monitoring stable.
Thrombin soaked gelfoam was used for hemostasis. The endplates were further prepared with a matchstick bur and curved curet. A trial was placed under lateral fluoroscopy. An anatomic peek cage filled with Progenix, 7mm in height, 14 x 11 mm footprint, was placed under lateral fluoroscopy. Electro-physiological monitoring stable. The introducer was then removed. The Caspar distraction pins were removed and bone wax was used for hemostasis.
An anterior cervical plate was sized under lateral fluoroscopy, And a 27.5 mm Atlantis Elite plate from Medtronic was used. 15 millimeter fixed angle screws were placed bilaterally at C6 and 7. Final AP and lateral fluoroscopy demonstrated the alignment of all instrumentation and of the cervical spine. The final locking mechanism was applied. Electrophysiological monitoring remained stable.
 
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