CPT® Code 22533

Arthrodesis, lateral extracavitary technique, including minimal discectomy to prepare interspace (other than for decompression); lumbar

Arthrodesis by lateral extracavitary technique, including minimal discectomy to prepare the interspace (other than for decompression), is a surgical procedure aimed at fusing vertebrae in the lumbar region of the spine. This technique involves a lateral approach, which necessitates the resection of ribs and exposure of the pleura and/or peritoneum to access the targeted vertebral segment. The procedure begins with a midline incision that is extended laterally, allowing the surgeon to expose the paraspinous muscle bundle over the lumbar vertebrae intended for fusion. The paraspinous muscles are carefully elevated off the spinous processes and laminae, and the muscle bundle is divided to facilitate access to the ribs. The ribs are dissected from the intercostal muscles and pleura, and subsequently resected, while ensuring that the intercostal nerve is identified and protected throughout the process. A high-speed drill is utilized to remove the transverse process and the lateral portions of the facet and pedicle, exposing the dural sac and vertebral body. In cases involving the lumbar spine, the peritoneum is also exposed and retracted to enhance visibility of the vertebral body. The procedure includes the removal of degenerated disc material to prepare the interspace for arthrodesis, followed by the decortication of the vertebral endplates. To facilitate the fusion, a bone graft, either allograft or autograft, is placed between the endplates. The procedure concludes with the placement of drains as necessary and closure of the incisions. This code is specifically designated for lumbar arthrodesis, distinguishing it from thoracic arthrodesis, which is reported with a different code.