CPT® Code 20664

1. Indications

The application of a cranial halo device using CPT® Code 20664 is indicated for patients with specific conditions that compromise the structural integrity of the skull. These indications include:

• Pediatric Patients Children with thin skull osteology may require stabilization to prevent further complications associated with their condition.
• Hydrocephalus Patients suffering from hydrocephalus, a condition characterized by an accumulation of cerebrospinal fluid within the brain, may need a cranial halo for additional support and stabilization.
• Osteogenesis Imperfecta Individuals with osteogenesis imperfecta, a genetic disorder that results in fragile bones, may also benefit from the application of a halo device to provide necessary cervical spine stabilization.

2. Procedure

The procedure for applying a cranial halo device involves several critical steps to ensure proper placement and stabilization. The steps are as follows:

• Step 1: Preparation of the Insertion Sites The first step involves preparing the areas where the pins will be inserted. This includes shaving the hair at the pin insertion sites and cleansing the skin with an anti-infective agent to reduce the risk of infection during the procedure.
• Step 2: Administration of Anesthesia A general anesthetic is administered to the patient to ensure comfort and prevent pain during the procedure. This is a crucial step, especially for pediatric patients who may be more sensitive to discomfort.
• Step 3: Positioning the Halo Device The cranial halo device is then positioned over the patient's skull. Careful attention is given to the placement of the device to ensure it is correctly aligned for optimal stabilization.
• Step 4: Insertion of Anterior Pins The anterior pins are inserted first. These pins are carefully placed through the skin and advanced until they engage the bone in a designated area known as the safe zone, which is located just below the greatest circumference of the skull. This placement is critical to avoid injury to surrounding structures.
• Step 5: Placement of Lateral Pins Next, lateral pins are inserted anterior to the temporalis muscle and fossa. This positioning is essential to prevent painful mastication and to avoid penetrating the thinner bone in the fossa area.
• Step 6: Insertion of Posterior Pins After the anterior and lateral pins are secured, the posterior pins are placed. The diagonally opposed pins are tightened simultaneously to ensure even pressure and stability.
• Step 7: Tightening and Securing Once the pins are in place, lock nuts are tightened to maintain the appropriate depth and stability of the halo device. This step is vital to ensure that the device remains securely attached throughout the treatment period.
• Step 8: Attachment of Rods Finally, rods are attached to the halo device and connected to a vest, cast, or traction setup, providing additional support and stabilization for the cervical spine.

3. Post-Procedure

Post-procedure care involves monitoring the patient for any signs of complications, such as infection or discomfort at the pin insertion sites. The patient may require follow-up visits to assess the stability of the halo device and the healing process. The removal of the halo device is included in the procedure, and it is typically performed once the physician determines that the cervical spine has stabilized adequately. Patients may also receive instructions on how to care for the insertion sites and manage any discomfort during the recovery period.