CPT® Code 22867

Insertion of interlaminar/interspinous process stabilization/distraction device, without fusion, including image guidance when performed, with open decompression, lumbar; single level

The procedure described by CPT® Code 22867 involves the insertion of an interlaminar or interspinous process stabilization or distraction device in the lumbar region of the spine. This procedure is performed without fusion and includes image guidance when applicable. The primary goal of this intervention is to stabilize the lumbar spine and alleviate pressure on the spinal nerves, particularly in patients suffering from conditions such as spinal stenosis, which can lead to pain and neurogenic claudication. The interlaminar devices are strategically placed adjacent to the lamina and feature two sets of wings that encircle the inferior and superior spinous processes, effectively limiting movement and providing stability. On the other hand, interspinous spacers are small implants positioned between the spinous processes, which are then expanded to relieve nerve pressure. The procedure typically begins with a small incision over the targeted lumbar disc, followed by careful dissection through the subcutaneous tissue and fascia. The multifidus muscle is detached, while preserving the supraspinous ligaments. The ligamentum flavum is elevated and partially resected, allowing for decompression of the exiting and transversing nerve roots, often utilizing a microscope for enhanced visibility. Additional techniques such as partial facetectomies and foraminal decompression may be employed to further relieve nerve compression. The insertion of the stabilization device is accomplished using incrementally sized dilators and a sizing instrument, ensuring the device is positioned optimally between the spinous processes. Once in place, the device is secured with screws, and drains may be utilized prior to closing the incision. This procedure is specifically coded as 22867 for a single level of the lumbar spine, distinguishing it from additional insertions at other levels, which would be reported with CPT® Code 22868.