CPT® Code 22524

Deleted

1. Indications

The procedure of percutaneous vertebral augmentation is indicated for the following conditions:

• Compression Fractures caused by osteoporosis, which is a condition that weakens bones, making them more susceptible to fractures.
• Multiple Myeloma is a type of cancer that affects plasma cells in the bone marrow, leading to bone damage and fractures.
• Primary or Metastatic Malignant Lesions that can weaken the vertebrae, resulting in fractures.
• Benign Lesions that may compromise the structural integrity of the vertebrae.
• Traumatic Injury to the spine that results in vertebral fractures.

2. Procedure

The procedure of percutaneous vertebral augmentation involves several key steps:

• Patient Positioning - The patient is placed in a prone position to allow optimal access to the affected vertebra.
• Incision and Needle Insertion - A small skin incision is made over the targeted vertebra. A needle is then advanced to the desired location within the vertebra to create a working channel.
• Biopsy (if needed) - If necessary, needle biopsies are obtained during this step to gather tissue samples for further analysis.
• Guidewire Placement - A guidewire is advanced through the needle to facilitate the next steps of the procedure.
• Cannula Insertion - The needle is withdrawn, and a cannula is advanced over the guidewire. The guidewire is then removed, allowing for the introduction of the mechanical device.
• Mechanical Device Insertion - A mechanical device, such as a miniature expandable jack or balloon tamp, is placed through the cannula. This device is expanded to create a cavity within the vertebra while contrast medium is instilled to visualize the cavity creation.
• Fracture Reduction - The mechanical device may also assist in reducing the fracture during the cavity creation process.
• Cavity Filling - Once the cavity is created, the mechanical device is removed, and the cavity is filled with morselized bone graft material, PMMA bone cement, or another bone graft substitute using a bone biopsy needle. The filling material is mixed with contrast medium to allow the physician to observe the filling process.
• Completion of Procedure - After the cavity is filled, the needle is withdrawn, and a second injection may be performed on the opposite side of the vertebral body to ensure comprehensive treatment.

3. Post-Procedure

Post-procedure care for patients undergoing percutaneous vertebral augmentation typically includes monitoring for any immediate complications, managing pain, and providing instructions for activity restrictions. Patients may be advised to avoid heavy lifting and strenuous activities for a specified period to allow for proper healing. Follow-up appointments may be scheduled to assess the success of the procedure and to monitor the patient's recovery progress. It is essential for healthcare providers to educate patients about signs of potential complications, such as increased pain, swelling, or signs of infection, and to ensure they understand the importance of adhering to post-procedure guidelines for optimal recovery.