CPT® Code 63180

Deleted

The procedure described by CPT® Code 63180 involves a laminectomy and the sectioning of dentate ligaments in the cervical region of the spine, specifically affecting one or two segments. The dentate ligaments are important anatomical structures that serve as lateral extensions of the pia mater, which is the innermost layer of the three membranes that encase the spinal cord. These ligaments extend through the arachnoid layer, the middle membrane, and attach to the dura mater, the outermost layer. There are a total of 21 dentate ligaments on each side of the spinal cord, spanning from the cervical vertebrae (C1) down to the thoracic vertebrae (T12). The primary function of the dentate ligaments is to create a longitudinal plane that separates the spinal cord into anterior and posterior regions, effectively organizing the spinal cord's structure. This organization is crucial as the ligaments spread out between the nerve roots, dividing the dorsal (posterior) and ventral (anterior) nerve roots. In cases where these ligaments become thickened or develop fibrosis, they can exert pressure on the adjacent nerve roots, leading to pain and neurological symptoms. The surgical intervention of sectioning the dentate ligaments is specifically indicated for the cervical spine, where the impingement on nerve roots occurs. The procedure begins with an incision over the cervical area where the dentate ligament is causing nerve root compression. The incision is deepened to reach the spinous processes, and the surrounding muscle is retracted to expose the lamina and facet joint. A bone drill is then utilized to remove part or all of the lamina, allowing access to the spinal cord and identification of the affected nerve roots. The dura mater is incised over the thickened dentate ligament, and the ligaments are sectioned to alleviate the pressure on the nerve roots. After the nerve roots are freed, the dural incision is closed, either with sutures or by using a graft to patch the dural membrane. This procedure is coded as 63180 when performed on one or two levels, while 63182 is used for procedures involving more than two levels.