CPT® Code 22838

Revision (eg, augmentation, division of tether), replacement, or removal of thoracic vertebral body tethering, including thoracoscopy, when performed

The CPT® Code 22838 refers to the revision, replacement, or removal of thoracic vertebral body tethering (VBT), which is a procedure that may include thoracoscopy when performed. This procedure is specifically designed for patients who have previously undergone vertebral body tethering as a treatment for adolescent idiopathic scoliosis. VBT serves as an alternative to traditional spinal fusion, allowing for the preservation of natural spinal growth and mobility. During the initial procedure, small screws are inserted into the affected vertebrae, and a flexible cord, known as a tether, is placed to correct the spinal curvature associated with scoliosis. The tether is strategically tightened to compress the growth plates on the convex side of the spinal curve, thereby inhibiting growth, while it is loosened on the concave side to permit continued growth. As the patient matures, adjustments to the tether may be necessary to accommodate ongoing spinal development. Although revisions are infrequent, occurring in fewer than 10% of cases, they may be required due to complications such as overcorrection, tether breakage, or dislodged screws. In these instances, the surgeon typically utilizes the same anterior approach as in the original surgery, employing either a mini-open thoracotomy or a thoracoscopic technique to access the spine for necessary corrections. The average age of patients undergoing this procedure is around 12 years, which is prior to the closure of the vertebral growth plates.