CPT® Code 0220T

1. Indications

The placement of a posterior intrafacet implant is indicated for patients experiencing conditions related to the facet joints that may lead to nerve compression and back pain. The following are specific indications for this procedure:

• Facet Joint Damage Damage to the facet joints that compromises their function and stability.
• Nerve Compression Conditions resulting in nerve compression due to facet joint degeneration or injury.
• Back Pain Chronic back pain associated with facet joint dysfunction.

2. Procedure

The procedure for the placement of a posterior intrafacet implant involves several critical steps to ensure successful implantation and stabilization of the affected vertebral segment:

• Step 1: Incision The procedure begins with an incision made over the affected vertebral segment in the back, allowing access to the underlying structures.
• Step 2: Imaging Guidance Imaging guidance is utilized as needed to enhance visualization of the facet joint and surrounding anatomy, ensuring precise placement of the implant.
• Step 3: Ligament Division The intervertebral ligament is carefully divided to expose the lamina, which is the bony structure at the back of the vertebra.
• Step 4: Lamina Exposure Part or all of the lamina is excised to provide access to the involved nerve root, which may be compressed due to facet joint issues.
• Step 5: Facet Joint Exploration The facet joints are explored to assess the extent of damage and to prepare for the placement of the implant.
• Step 6: Implant Placement A posterior intrafacet implant, such as a facet screw system or a locking screw and nut device, is then placed between the facets in the intervertebral space to stabilize the joint.
• Step 7: Bone Graft Harvesting If a bone graft is required, it is harvested either locally or from the iliac crest or another donor site, prepared, and placed between the facets to enhance stability.
• Step 8: Bone Cement Injection Bone cement may be injected as needed to further secure the implant and provide additional support.
• Step 9: Wound Closure Upon completion of the procedure, bleeding is controlled through coagulation, the wound is irrigated, and the incisions are closed to promote healing.

3. Post-Procedure

After the procedure, patients are typically monitored for any complications and may require pain management strategies. Recovery involves following specific post-operative care instructions, which may include restrictions on physical activity and guidelines for wound care. The expected recovery time can vary based on individual patient factors and the extent of the procedure performed. Regular follow-up appointments are essential to assess healing and the effectiveness of the implant in alleviating symptoms.