CPT® Code 63191

The procedure described by CPT® Code 63191 involves a laminectomy with sectioning of the spinal accessory nerve, which is also known as cranial nerve XI (CN XI). This nerve is primarily responsible for motor functions and originates from nerve cell bodies located in the cervical spinal cord and the caudal medulla. The spinal accessory nerve innervates key muscles in the neck and back, specifically the sternocleidomastoid and trapezius muscles. The sectioning of this nerve is typically indicated for the treatment of severe spasmodic torticollis, a condition also referred to as cervical dystonia. Spasmodic torticollis is characterized by involuntary muscle contractions that lead to abnormal head positioning, accompanied by pain and numbness that may radiate into the shoulder, arm, and hand. The surgical approach begins with an incision over one or more cervical vertebrae, which is then extended to expose the underlying structures. The procedure involves retracting the muscles away from the lamina and facet joint, followed by the use of a bone drill to remove part or all of the lamina, thereby exposing the spinal cord. Once the spinal accessory nerve is identified, electrical stimulation is applied to individual nerve fibers to pinpoint the specific motor fibers responsible for the spasticity and associated pain, after which these nerve fibers are sectioned to alleviate the symptoms.