CPT® Code 22206

Osteotomy of spine, posterior or posterolateral approach, 3 columns, 1 vertebral segment (eg, pedicle/vertebral body subtraction); thoracic

A three-column osteotomy of the spine, commonly known as a pedicle subtraction osteotomy, is a surgical procedure performed on a single thoracic segment using a posterior or posterolateral approach, as indicated by CPT® Code 22206. The spine is anatomically divided into three columns: the anterior column, which consists of the vertebral body; the middle column, made up of two robust pedicles that encase the vertebral foramen through which the spinal cord traverses; and the posterior column, which includes the lamina, two transverse processes, and the spinous process. This type of osteotomy is particularly relevant in the context of addressing complex spinal deformities, often necessitating the surgical intervention of all three columns. The procedure begins with an incision made in the skin over the affected vertebral segment, or alternatively, to the side of the segment that requires reconstruction. Following the incision, the fascia is cut, and a subperiosteal dissection is performed along the spinal process, lamina, both transverse processes, and the rib head of the targeted vertebral segment. The surgical approach is designed to facilitate the resection of the posterior segment while preserving the integrity of the pedicles, which is crucial for maintaining spinal stability. This detailed and methodical approach allows for effective correction of spinal deformities while minimizing potential complications associated with the procedure.