CPT® Code 22860

Add-On Code

1. Indications

The total disc arthroplasty procedure is indicated for patients suffering from severe degenerative disc disease or other conditions that have led to significant damage of the intervertebral disc, resulting in chronic pain and functional impairment. This procedure is typically considered when conservative treatments have failed to provide relief. The specific indications for performing total disc arthroplasty at the lumbar region include:

• Severe Degenerative Disc Disease - A condition characterized by the deterioration of the intervertebral disc, leading to pain and reduced mobility.
• Disc Herniation - The displacement of disc material that can compress spinal nerves, causing pain, numbness, or weakness in the lower extremities.
• Spinal Instability - A condition where the spine is unable to maintain its normal alignment, often resulting in pain and functional limitations.
• Failed Conservative Treatment - Patients who have not responded to non-surgical interventions such as physical therapy, medications, or injections may be candidates for this surgical procedure.

2. Procedure

The total disc arthroplasty procedure involves several critical steps to ensure successful implantation of the artificial disc. The steps are as follows:

• Step 1: Anterior Approach - The surgeon begins by making an incision in the abdominal area to access the lumbar spine. This anterior approach allows for direct access to the intervertebral disc without disturbing the spinal cord or nerve roots.
• Step 2: Muscle Retraction - Once the abdominal cavity is accessed, the intervertebral muscles are carefully retracted to expose the lumbar vertebrae. This step is crucial for providing a clear view of the target disc.
• Step 3: Identification of the Target Disc - Using radiological guidance, the surgeon identifies the specific intervertebral disc that requires replacement. This ensures accuracy in targeting the affected area.
• Step 4: Discectomy - The damaged disc material is removed using a rongeur, which cleans out the intervertebral disc space. This preparation is essential for the proper placement of the artificial disc.
• Step 5: Insertion of Artificial Disc - The artificial disc, typically consisting of two metal endplates and a polyethylene insert, is inserted into the prepared disc space. The endplates are initially collapsed and seated into the adjacent vertebrae.
• Step 6: Distraction and Locking Mechanism - The endplates are then distracted to open them, allowing the polyethylene insert to be placed securely within the endplates. A snap-lock mechanism is used to ensure that the insert is firmly seated.
• Step 7: Closure - After confirming the proper placement of the artificial disc, the surgeon closes the surgical wounds and may place a drain to prevent fluid accumulation in the surgical site.

3. Post-Procedure

Following the total disc arthroplasty procedure, patients are typically monitored in a recovery area before being transferred to a hospital room. Post-operative care may include pain management, physical therapy, and instructions for activity restrictions to promote healing. Patients are advised to avoid heavy lifting and twisting motions for a specified period. The expected recovery time can vary, but many patients begin to experience relief from symptoms within weeks of surgery. Regular follow-up appointments are essential to monitor the healing process and ensure the artificial disc is functioning as intended. Any signs of complications, such as infection or implant failure, should be reported to the healthcare provider immediately.