CPT® Code 22525

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1. Indications

The procedure of percutaneous vertebral augmentation is indicated for patients experiencing compression fractures of the vertebrae due to various underlying conditions. These indications include:

• Osteoporosis - A condition characterized by weakened bones, making them more susceptible to fractures.
• Multiple Myeloma - A type of cancer that affects plasma cells in the bone marrow, leading to bone lesions and fractures.
• Primary or Metastatic Malignant Lesions - Cancerous growths that originate in the vertebrae or spread from other parts of the body, causing structural compromise.
• Benign Lesions - Non-cancerous growths that may weaken the vertebrae and lead to fractures.
• Traumatic Injury - Fractures resulting from accidents or falls that impact the spine.

2. Procedure

The percutaneous vertebral augmentation procedure involves several key steps to ensure effective treatment of the compression fracture. The steps are as follows:

• Step 1: Patient Positioning - The patient is placed in a prone position to facilitate access to the affected vertebra. This positioning is crucial for the subsequent steps of the procedure.
• Step 2: 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, creating a working channel. This step may also include obtaining needle biopsies if necessary.
• Step 3: Guidewire Placement - A guidewire is introduced through the needle to provide a pathway for further instrumentation. Once the guidewire is in place, the needle is withdrawn, leaving the guidewire in position.
• Step 4: Cannula Insertion - A cannula is advanced over the guidewire, which is then removed. This allows for the introduction of the mechanical device in the next steps.
• Step 5: Cavity Creation - A mechanical device, such as an expandable balloon tamp, is inserted through the cannula. The device is expanded to create a cavity within the vertebra while contrast medium is instilled to visualize the cavity formation.
• Step 6: Fracture Reduction - The mechanical device may also assist in reducing the fracture during the cavity creation process, helping to restore the vertebra's structural integrity.
• Step 7: Filling the Cavity - Once the cavity is created, it is filled with morselized bone graft material, polymethylmethacrylate (PMMA) bone cement, or another suitable bone graft substitute. The filling material is mixed with contrast medium to allow the physician to monitor the filling process effectively.
• Step 8: Completion of the 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 involves monitoring for any immediate complications, such as bleeding or infection at the incision site. Patients may be advised to limit physical activity for a short period to allow for proper healing. Pain management strategies may be implemented to address any discomfort following the procedure. Follow-up appointments are essential to assess the success of the augmentation and to monitor the patient's recovery progress. Additionally, patients may be educated on lifestyle modifications and exercises to strengthen the spine and prevent future fractures.