CPT® Code 22851

Deleted

1. Indications

The application of intervertebral biomechanical device(s) is indicated for various conditions that necessitate spinal fusion. These indications may include:

• Vertebral Defects The presence of defects in the vertebrae that require stabilization to restore structural integrity.
• Degenerative Disc Disease Conditions where the intervertebral discs have deteriorated, leading to instability and pain.
• Spinal Instability Situations where the spine is unstable due to trauma, tumors, or other pathological conditions.
• Failed Back Surgery Syndrome Cases where previous surgical interventions have not achieved the desired outcomes, necessitating further stabilization.

2. Procedure

The procedure for the application of intervertebral biomechanical device(s) involves several critical steps, which are outlined as follows:

• Step 1: Preparation of the Disc Space The initial step involves the careful removal of the nucleus pulposus, which is the inner gel-like core of the intervertebral disc. This is followed by reaming the disc space to remove any subchondral bone, ensuring a clean and suitable environment for the device placement. Additionally, drill holes may be created to facilitate the insertion of screws or bone dowels, which will aid in securing the biomechanical device.
• Step 2: Application of the Distraction Device A distraction device is then applied to separate the vertebral bodies. This step is crucial as it creates the necessary space for the intervertebral biomechanical device to be inserted effectively.
• Step 3: Insertion of the Intervertebral Device The selected intervertebral biomechanical device is then inserted into the prepared disc space. If a titanium cage, ring, or box is utilized, it is fixed in place with screws to ensure stability. The device may also be packed with bone grafts, which can be either allografts or autografts, to promote fusion and healing.
• Step 4: Application of Methylmethacrylate (if applicable) In cases where methylmethacrylate is used, the disc space is first coated with gelfoam to prevent leakage into the epidural space. The methylmethacrylate cement is then mixed and injected into the disc space using a syringe and intracath, while the vertebral body distracter is carefully removed to allow the cement to set properly.

3. Post-Procedure

Post-procedure care following the application of intervertebral biomechanical device(s) typically involves monitoring for any complications, such as infection or improper placement of the device. Patients may be advised on activity restrictions to promote healing and ensure the stability of the spine. Follow-up imaging may be required to assess the positioning of the device and the progress of spinal fusion. Additionally, pain management strategies will be implemented to address any discomfort experienced during the recovery phase.