CPT® Code 22522

Deleted

1. Indications

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

• Compression Fractures Stabilization of compression fractures caused by osteoporosis of the spine.
• Aggressive Hemangiomas Treatment of aggressive hemangiomas located in the vertebral body.
• Palliative Treatment Management of pathological fractures resulting from benign or malignant neoplasms of the spine.

2. Procedure

The procedure of percutaneous vertebroplasty involves several critical steps to ensure effective treatment:

• Patient Positioning The patient is placed in a prone position to allow optimal access to the spine for the procedure.
• Imaging Guidance Fluoroscopic or CT guidance is utilized to accurately identify the specific vertebral level that requires vertebroplasty.
• Administration of Anesthesia Local anesthesia is administered to the patient to ensure comfort during the procedure.
• Needle Advancement A spinal needle is advanced into one side of the vertebral body, and deep local and subperiosteal anesthesia is provided to enhance pain control.
• 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 advancing a spinal needle into the vertebral body using either a transpedicular or parapedicular approach. A mixture of polymethylmethacrylate (PMMA) bone cement and a contrast medium, such as sterile barium or tungsten powder, is injected into the vertebral body.
• Observation of Cement Diffusion The physician observes the diffusion of the bone cement and contrast medium throughout the intertrabecular bone marrow space to ensure adequate filling and stabilization.
• Needle Withdrawal After the injection, the needle is withdrawn from the vertebral body.
• Second Injection (if necessary) A second injection may be performed on the opposite side of the vertebral body, with or without a bone biopsy, depending on the clinical need.

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 for patients to follow up with their healthcare provider to assess the effectiveness of the procedure and to monitor for any potential complications. Recovery time may vary, but many patients can resume normal activities within a short period, depending on their overall health and the extent of the procedure performed.