CPT® Code 0309T

Deleted

1. Indications

Arthrodesis using the pre-sacral interbody technique is indicated for several specific spinal conditions, which include:

• Pseudoarthritis - A condition characterized by the failure of a previous spinal fusion to heal properly, leading to persistent pain and instability.
• Unsuccessful Previous Disc Fusion - Patients who have undergone prior fusion surgery that did not achieve the desired outcome may benefit from this technique.
• Spinal Stenosis - A narrowing of the spinal canal that can cause nerve compression and pain, often requiring surgical intervention.
• Spondylolisthesis (Grade I) - A condition where one vertebra slips forward over another, which can lead to instability and discomfort.
• Degenerative Disc Disease - A condition resulting from the deterioration of intervertebral discs, leading to pain and reduced mobility, which is documented through patient history and imaging studies.

2. Procedure

The procedure for arthrodesis using the pre-sacral interbody technique involves several critical steps, each designed to ensure the successful fusion of the lumbar spine at the L4-L5 interspace:

• Step 1: Incision - A small incision, typically measuring between 15 to 20 mm, is made laterally to the coccyx. This minimally invasive approach is essential for reducing recovery time and minimizing tissue damage.
• Step 2: Guide Introducer Insertion - Under fluoroscopic guidance, a blunt guide introducer is inserted through the incision. This instrument is carefully advanced along the midline, targeting the anterior surface of the sacrum to ensure accurate placement.
• Step 3: Guide Pins and Dilators - Once the guide introducer is in place, guide pins are inserted and tapped into the sacrum. Graduated dilators are then used to create a working channel, allowing for the safe passage of surgical instruments necessary for the procedure.
• Step 4: Debulking the Nucleus Pulposus - The nucleus pulposus, the gel-like center of the intervertebral disc, is debulked to prepare the disc space for fusion. This step is crucial for removing any degenerated tissue that may hinder the fusion process.
• Step 5: Bone Graft Material Injection - Bone graft material is injected into the prepared disc space. This material can be an autograft taken from the patient’s own body or an allograft sourced from a donor, both of which are essential for promoting bone healing and fusion.
• Step 6: Insertion of Threaded Rod - A threaded rod is then inserted to maintain the height of the disc and the neural foramen, ensuring proper alignment and stability during the healing process.
• Step 7: Closure - After the necessary instruments are withdrawn, the incision is closed with sutures, completing the procedure.

3. Post-Procedure

Post-procedure care following arthrodesis using the pre-sacral interbody technique typically involves monitoring for any complications and managing pain. Patients may be advised to limit physical activity and follow specific rehabilitation protocols to promote healing. The expected recovery period can vary based on individual patient factors, but adherence to post-operative instructions is crucial for achieving optimal outcomes. Regular follow-up appointments may be scheduled to assess the fusion progress and overall spinal health.