CPT® Code 63304

1. Indications

The vertebral corpectomy procedure is indicated for the excision of intraspinal lesions that are intradural and located within the cervical spine. The specific indications for performing this procedure include:

• Intraspinal Lesion The presence of a tumor or lesion within the spinal canal that requires surgical intervention for removal.
• Intradural Location Lesions that extend into or lie within the dura mater, necessitating careful dissection and excision to prevent further neurological compromise.
• Cervical Spine Involvement The need to address lesions affecting a single segment of the cervical spine, which may be causing symptoms such as pain, neurological deficits, or spinal instability.

2. Procedure

The vertebral corpectomy procedure involves several critical steps, each designed to ensure the safe and effective removal of the lesion while preserving surrounding structures. The procedural steps include:

• Step 1: Anterior Approach The procedure begins with an anterior approach to the cervical spine, initiated by making a skin incision in the anterior aspect of the neck. This incision allows access to the underlying structures of the cervical spine.
• Step 2: Dissection of Soft Tissues Following the incision, the surgeon carefully dissects the soft tissues and muscles overlying the cervical spine. This step is crucial for exposing the affected vertebral segment while minimizing trauma to surrounding tissues.
• Step 3: Retraction of Adjacent Structures The trachea and esophagus are retracted to provide a clear view of the cervical spine. This retraction is essential for safely accessing the vertebral body and surrounding areas.
• Step 4: Exposure of the Affected Segment The affected segment of the cervical spine is then exposed, allowing the surgeon to visualize the intervertebral discs and the vertebral body that need to be removed.
• Step 5: Removal of Intervertebral Discs The intervertebral discs located above and below the vertebral body are removed first. This is done with the assistance of a surgical microscope, which aids in the careful dissection of the discs from surrounding tissues.
• Step 6: Excision of the Vertebral Body After the discs are removed, the vertebral body is excised. The surgeon identifies and explores the lesion or tumor located in the spinal canal during this step.
• Step 7: Dural Incision (if necessary) If the lesion is determined to lie within or extend into the dura, the dura is incised to allow for complete removal of the lesion. This step requires precision to avoid damaging surrounding neural structures.
• Step 8: Dissection and Removal of the Lesion The lesion or tumor is carefully dissected free of surrounding tissues with the aid of the operating microscope and removed. This meticulous approach is vital for ensuring complete excision.
• Step 9: Dural Repair After the lesion is removed, the dura is repaired using sutures or a dural graft to restore the protective covering of the spinal cord.
• Step 10: Bone Grafting and Fusion Separately reportable bone grafting and fusion procedures are performed to support the anterior aspect of the spine where the discs and vertebral body have been removed. The surrounding bone is contoured to facilitate the placement of the graft and ensure fusion with adjacent bone.
• Step 11: Stabilization (if applicable) Separately reportable spine instrumentation may also be utilized to stabilize the spine, providing additional support and stability post-surgery.
• Step 12: Closure Upon completion of the procedure, bleeding is controlled, and the soft tissues and skin are closed in layers to promote healing.

3. Post-Procedure

Post-procedure care following a vertebral corpectomy includes monitoring for any complications such as infection, bleeding, or neurological deficits. Patients may require pain management and physical therapy to aid in recovery. The expected recovery period can vary based on individual patient factors and the extent of the surgery performed. Follow-up appointments are essential to assess the healing process and the effectiveness of the intervention, as well as to monitor for any recurrence of the lesion or complications related to the surgery.