CPT® Code 22848

Add-On Code

Pelvic fixation (attachment of caudal end of instrumentation to pelvic bony structures) other than sacrum (List separately in addition to code for primary procedure)

Pelvic fixation is a surgical procedure that involves the attachment of the caudal end of spinal instrumentation to pelvic bony structures, excluding the sacrum. This procedure is typically performed in conjunction with a spinal arthrodesis, commonly known as spinal fusion, and is reported separately using CPT® Code 22848. The primary purpose of pelvic fixation is to address issues such as pelvic obliquity, which can arise from conditions like scoliosis, leading to imbalanced postures during sitting or standing. Additionally, pelvic fixation may be indicated following severe traumatic injuries to the spine or as part of radical surgical interventions for spinal tumors. Various fixation devices are utilized in this procedure, including L-rods, S-rods, transiliac screws, iliosacral fixation, and iliac screws. The surgical approach can be anterior, posterior, or a combination of both, depending on the specific clinical scenario. During the procedure, the surgeon carefully retracts overlying muscles and manages blood vessels to ensure a clear surgical field. In cases of scoliosis, intraoperative halo-femoral traction may be employed to correct pelvic obliquity, involving the application of a halo-traction device to the skull and the placement of a femoral pin. This traction system is weighted to exert distraction forces, aiding in the alignment of the spinal curvature and the iliac crests. Ultimately, the caudal end of the spinal instrumentation is securely attached to rods and/or screws anchored in the pelvis, typically within the iliac bones, and may involve the use of separately reportable bone grafts to enhance the stability of the fixation device.