CPT® Code 22208

Add-On Code

Osteotomy of spine, posterior or posterolateral approach, 3 columns, 1 vertebral segment (eg, pedicle/vertebral body subtraction); each additional vertebral segment (List separately in addition to code for primary procedure)

A three-column osteotomy of the spine, commonly known as a pedicle subtraction osteotomy, is a surgical procedure aimed at correcting complex spinal deformities. This specific procedure, identified by CPT® Code 22208, is performed on a single vertebral segment, typically in the thoracic region, utilizing a posterior or posterolateral approach. 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. The necessity for a three-column osteotomy arises in cases of significant spinal deformities, where traditional methods may not suffice. The procedure involves making an incision in the skin over the affected vertebral segment, followed by careful dissection of the fascia and subperiosteal layers to access the spinal structures. The surgical technique requires meticulous resection of the posterior elements of the vertebra while preserving the pedicles, which are crucial for maintaining spinal stability. The ultimate goal of this osteotomy is to realign the spine and restore its normal curvature, thereby alleviating symptoms associated with the deformity. Intraoperative imaging is employed to assess the correction of the deformity, ensuring that the surgical objectives are met effectively.