CPT® Code 0375T

Deleted

1. Indications

The total disc arthroplasty procedure is indicated for patients experiencing significant cervical spine issues that necessitate intervention. The following conditions may warrant this surgical approach:

• Severe disc degeneration - This condition involves the deterioration of the intervertebral disc, leading to pain and reduced function.
• Herniated disc - A herniated disc occurs when the inner gel-like core of the disc protrudes through the outer layer, potentially compressing nearby nerves.
• Spinal stenosis - This is a narrowing of the spinal canal that can lead to nerve compression, causing pain, weakness, or numbness in the arms or hands.
• Radiculopathy - This condition is characterized by pain that radiates along the path of a nerve due to compression or irritation, often caused by disc issues.
• Myelopathy - Myelopathy refers to spinal cord dysfunction due to compression, which can result from degenerative disc disease or other cervical spine pathologies.

2. Procedure

The total disc arthroplasty procedure involves several critical steps to ensure successful implantation of the artificial disc. Each step is essential for achieving the desired outcome and involves meticulous surgical techniques.

• Step 1: Anterior Approach - The procedure begins with an incision made in the front of the neck, just off the midline of the spine. This approach allows the surgeon to access the cervical spine directly while minimizing damage to surrounding structures.
• Step 2: Soft Tissue Dissection - After the incision, the soft tissues of the neck are carefully dissected. The esophagus is retracted to provide a clear view of the cervical vertebrae. During this step, the surgeon identifies and protects critical nerves and arteries to prevent injury.
• Step 3: Discectomy - The intervertebral muscles are retracted, and the diseased or damaged disc is located and removed. This step is crucial as it alleviates pressure on the spinal cord and nerve roots.
• Step 4: End Plate Preparation - The end plates of the vertebrae above and below the disc space are milled and shaped to create a suitable surface for the artificial disc. This preparation ensures proper fit and stability of the implant.
• Step 5: Artificial Disc Insertion - Tension is applied to the vertebral bodies to open the intervertebral space, allowing for the placement of the artificial disc. The disc, which consists of two metal plates surrounding a polyurethane core and saline cushion, is inserted into the prepared space.
• Step 6: Compression and Stabilization - Once the artificial disc is in place, tension is released from the vertebral bodies. This compression holds the artificial disc securely against the bony end plates, ensuring stability and function.
• Step 7: Additional Levels - If necessary, the same procedure is repeated for at least two additional cervical disc levels that require replacement, ensuring comprehensive treatment of the patient's condition.

3. Post-Procedure

After the total disc arthroplasty procedure, patients typically undergo a recovery period that may involve monitoring for any immediate complications. Post-operative care includes pain management, physical therapy, and follow-up appointments to assess the healing process and the functionality of the artificial disc. Patients are often advised to avoid strenuous activities and heavy lifting during the initial recovery phase to promote healing. The expected recovery time can vary based on individual factors, but many patients can gradually return to normal activities within a few weeks, depending on their overall health and adherence to post-operative guidelines.