CPT® Code 22520

Deleted

1. Indications

The procedure of percutaneous vertebroplasty is indicated for the following conditions:

• Compression fractures caused by osteoporosis of the spine.
• Aggressive hemangiomas of the vertebral body.
• Palliative treatment of pathological fractures due to benign or malignant neoplasms of the spine.

2. Procedure

The procedure of percutaneous vertebroplasty involves several critical steps to ensure effective stabilization of the affected vertebra.

• Patient positioning - The patient is placed in a prone position to provide optimal access to the thoracic vertebra requiring treatment.
• Imaging guidance - Fluoroscopic or CT guidance is utilized to accurately identify the specific vertebral level that necessitates the vertebroplasty.
• Administration of local anesthesia - Local anesthesia is administered to the patient to minimize discomfort during the procedure.
• Needle advancement - A spinal needle is advanced into one side of the vertebral body. Deep local and subperiosteal anesthesia is also applied to enhance patient comfort.
• Bone biopsy (if needed) - If a biopsy is required, a small incision is made in the skin, and a bone biopsy needle is advanced into the vertebral body to obtain a bone sample, which is then sent for pathological examination.
• Injection of bone cement - The percutaneous vertebroplasty is performed by injecting a mixture of polymethylmethacrylate (PMMA) bone cement and a contrast medium into the vertebral body. The mixture is observed as it diffuses throughout the intertrabecular bone marrow space.
• Needle withdrawal - After the initial injection, the needle is withdrawn from the vertebral body.
• Second injection - A second injection may be performed on the opposite side of the vertebral body, with or without a bone biopsy, depending on the clinical situation.

3. Post-Procedure

Post-procedure care for patients undergoing percutaneous vertebroplasty typically includes monitoring for any immediate complications, such as bleeding or infection at the injection site. Patients may experience some discomfort or pain following the procedure, which can be managed with prescribed analgesics. It is essential to provide instructions regarding activity restrictions and follow-up appointments to assess the effectiveness of the procedure and the patient's recovery. The expected recovery time may vary, but many patients report significant pain relief and improved mobility shortly after the procedure.