CPT® Code 22548

Arthrodesis, anterior transoral or extraoral technique, clivus-C1-C2 (atlas-axis), with or without excision of odontoid process

The procedure described by CPT® Code 22548 involves arthrodesis, which is a surgical technique aimed at fusing the clivus, a sloping surface at the back of the skull, to the first and second cervical vertebrae, known as C1 (atlas) and C2 (axis). This fusion is critical for stabilizing the head and preventing excessive movement that could lead to neurological complications. The clivus is anatomically significant as it forms part of the base of the skull, extending from the dorsum sellae to the foramen magnum, where the spinal cord exits the skull. The procedure can be performed using either a transoral approach, which involves accessing the surgical site through an incision in the soft palate, or an extraoral approach, which may include retropharyngeal or anterolateral techniques. During the surgery, the soft palate is split and retracted to provide access to the clivus-C1-C2 interspaces. The anterior arch of the atlas and the odontoid process, a peg-like structure on the axis, may be excised if necessary. The odontoid process can obstruct the spinal cord, and its removal is performed under fluoroscopic guidance to ensure precision. The fusion is achieved by placing bone grafts between the clivus and the cervical vertebrae, and additional fixation methods, such as wire fixation or other internal devices, may be utilized to ensure stability during the healing process. This procedure is essential for patients with specific conditions affecting the cervical spine, as it addresses both structural stability and potential compression of neural elements.