CPT® Code 63182

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The procedure described by CPT® Code 63182 involves a laminectomy and sectioning of the dentate ligaments in the cervical region of the spine, specifically when more than two segments are affected. The dentate ligaments are important anatomical structures that extend laterally from the pia mater, which is the innermost layer of the three membranes that encase the spinal cord. These ligaments traverse 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 first cervical vertebra (C1) to the twelfth thoracic vertebra (T12). Their primary function is to create a longitudinal plane that divides the spinal cord into anterior and posterior sections, effectively separating the dorsal and ventral nerve roots. When these ligaments become thickened or develop fibrosis, they can exert pressure on the adjacent nerve roots, leading to pain and other neurological symptoms. The surgical intervention of sectioning the dentate ligaments is specifically indicated for cases where these ligaments in the cervical spine are causing such impingement. The procedure begins with an incision over the cervical area where the nerve roots are being compressed. 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, which is subsequently sectioned to alleviate the pressure on the nerve roots. After the ligaments are cut, the dural incision is either sutured closed or patched with a graft to ensure proper healing. This procedure is distinct from similar interventions that involve sectioning the dentate ligaments at one or two levels, which is coded differently under CPT® Code 63180.