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Vertebral corpectomy is a surgical procedure that involves the removal of a vertebral body along with the intervertebral discs situated above and below the affected vertebra. This operation is specifically indicated for the excision of an intraspinal lesion, which may include tumors or other abnormal growths located within the spinal canal. The term "intradural" refers to the location of the lesion being within or extending into the dura mater, the protective covering of the spinal cord. The procedure is performed on a single segment of the thoracic spine, which is the middle section of the vertebral column. Access to the thoracic spine is achieved through a transthoracic approach, necessitating a thoracotomy, which is an incision made in the chest wall. This approach allows for adequate exposure of the thoracic spine, enabling the surgeon to perform the corpectomy effectively. Typically, this procedure is carried out by a surgical team, often involving a thoracic surgeon for the exposure and a spine surgeon for the corpectomy itself. The operation requires careful dissection of the overlying muscles and may involve the resection of one or more ribs to facilitate access to the spine. The use of surgical microscopes aids in the precise removal of the intervertebral discs and the vertebral body, as well as in the careful dissection of the lesion from surrounding tissues. Following the excision, the dura may need to be incised if the lesion is found to be within or extending into it, and subsequent repair of the dura is performed to ensure the integrity of the spinal canal. Additionally, procedures for bone grafting and spinal fusion may be conducted to support the spine after the removal of the vertebral body and discs.
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The vertebral corpectomy procedure is indicated for the following conditions:
The vertebral corpectomy procedure involves several critical steps to ensure successful excision of the lesion. First, the surgical team prepares the patient and positions them appropriately for access to the thoracic spine. The skin over the thorax is incised to provide access to the necessary vertebral levels. Following the incision, the overlying muscles are carefully dissected to expose the thoracic cavity. In this procedure, one or more of the upper ribs may be resected to facilitate adequate exposure of the spine. Rib spreaders are utilized to maintain the incision and allow for optimal visibility and access to the thoracic spine.
Once the thoracic spine is adequately exposed, the pleura are incised, and the affected portion of the thoracic spine is accessed. The intervertebral discs located above and below the targeted vertebral body are removed first, utilizing a surgical microscope to aid in the dissection and removal process. The discs are meticulously dissected from the surrounding tissues to minimize damage to adjacent structures. After the discs are excised, the vertebral body itself is removed, allowing the surgeon to identify and explore the lesion or tumor within the spinal canal.
If the lesion is determined to be within or extending into the dura mater, the dura is incised to allow for direct access to the tumor. The lesion is then carefully dissected free from surrounding tissues with the assistance of an operating microscope, ensuring precision and minimizing trauma to adjacent structures. Once the lesion is completely excised, the dura is repaired using sutures or a dural graft to restore the integrity of the spinal canal. Following the corpectomy, any necessary bone grafting and fusion procedures are performed to support the anterior aspect of the spine where the vertebral body and discs have been removed. The surrounding bone is contoured to facilitate the placement of the graft, ensuring proper fusion with adjacent bone. Additionally, spine instrumentation may be utilized to stabilize the spine post-procedure.
After the vertebral corpectomy, patients typically require close monitoring in a postoperative setting. The expected recovery process may involve pain management, physical therapy, and gradual mobilization to promote healing. The surgical site will need to be monitored for any signs of infection or complications. Patients may also need follow-up imaging studies to assess the success of the procedure and the integration of any bone grafts used. Rehabilitation may be necessary to restore function and strength in the affected area, and the healthcare team will provide specific instructions regarding activity restrictions and care of the surgical site during the recovery period.
| Short Descr | REMOVE VERT IDRL BODY THRC | Medium Descr | VERTEBRAL CORPECTOMY LES 1 SEG IDRL THRC TTHRC | Long Descr | Vertebral corpectomy (vertebral body resection), partial or complete, for excision of intraspinal lesion, single segment; intradural, thoracic by transthoracic approach | Status Code | Active Code | Global Days | 090 - Major Surgery | PC/TC Indicator (26, TC) | 0 - Physician Service Code | Multiple Procedures (51) | 2 - Standard payment adjustment rules for multiple procedures apply. | Bilateral Surgery (50) | 0 - 150% payment adjustment for bilateral procedures does NOT apply. | Physician Supervisions | 09 - Concept does not apply. | Assistant Surgeon (80, 82) | 2 - Payment restriction for assistants at surgery does not apply to this procedure... | Co-Surgeons (62) | 1 - Co-surgeons could be paid, though supporting documentation is required... | Team Surgery (66) | 0 - Team surgeons not permitted for this procedure. | Diagnostic Imaging Family | 99 - Concept Does Not Apply | APC Status Indicator | Inpatient Procedures, not paid under OPPS | Type of Service (TOS) | 2 - Surgery | Berenson-Eggers TOS (BETOS) | P1G - Major procedure - Other | MUE | 1 | CCS Clinical Classification | 9 - Other OR therapeutic nervous system procedures |
This is a primary code that can be used with these additional add-on codes.
| 22840 | Addon Code MPFS Status: Active Code APC N ASC N1 Physician Quality Reporting CPT Assistant Article Posterior non-segmental instrumentation (eg, Harrington rod technique, pedicle fixation across 1 interspace, atlantoaxial transarticular screw fixation, sublaminar wiring at C1, facet screw fixation) (List separately in addition to code for primary procedure) | 22841 | Addon Code MPFS Status: Bundled Code APC C Physician Quality Reporting CPT Assistant Article Internal spinal fixation by wiring of spinous processes (List separately in addition to code for primary procedure) | 22842 | Addon Code MPFS Status: Active Code APC N ASC N1 Physician Quality Reporting CPT Assistant Article Posterior segmental instrumentation (eg, pedicle fixation, dual rods with multiple hooks and sublaminar wires); 3 to 6 vertebral segments (List separately in addition to code for primary procedure) | 22843 | Addon Code MPFS Status: Active Code APC C Physician Quality Reporting CPT Assistant Article Posterior segmental instrumentation (eg, pedicle fixation, dual rods with multiple hooks and sublaminar wires); 7 to 12 vertebral segments (List separately in addition to code for primary procedure) | 22844 | Addon Code MPFS Status: Active Code APC C Physician Quality Reporting CPT Assistant Article Posterior segmental instrumentation (eg, pedicle fixation, dual rods with multiple hooks and sublaminar wires); 13 or more vertebral segments (List separately in addition to code for primary procedure) | 22845 | Addon Code MPFS Status: Active Code APC N ASC N1 Physician Quality Reporting CPT Assistant Article Illustration for Code Anterior instrumentation; 2 to 3 vertebral segments (List separately in addition to code for primary procedure) | 22846 | Addon Code MPFS Status: Active Code APC C Physician Quality Reporting CPT Assistant Article Illustration for Code Anterior instrumentation; 4 to 7 vertebral segments (List separately in addition to code for primary procedure) | 22847 | Addon Code MPFS Status: Active Code APC C Physician Quality Reporting CPT Assistant Article Illustration for Code Anterior instrumentation; 8 or more vertebral segments (List separately in addition to code for primary procedure) | 22848 | Addon Code MPFS Status: Active Code APC N Physician Quality Reporting CPT Assistant Article Pelvic fixation (attachment of caudal end of instrumentation to pelvic bony structures) other than sacrum (List separately in addition to code for primary procedure) | 22853 | CPT Add On MPFS Status: Active Code APC N ASC N1 Insertion of interbody biomechanical device(s) (eg, synthetic cage, mesh) with integral anterior instrumentation for device anchoring (eg, screws, flanges), when performed, to intervertebral disc space in conjunction with interbody arthrodesis, each interspace (List separately in addition to code for primary procedure) | 22854 | CPT Add On MPFS Status: Active Code APC N ASC N1 Insertion of intervertebral biomechanical device(s) (eg, synthetic cage, mesh) with integral anterior instrumentation for device anchoring (eg, screws, flanges), when performed, to vertebral corpectomy(ies) (vertebral body resection, partial or complete) defect, in conjunction with interbody arthrodesis, each contiguous defect (List separately in addition to code for primary procedure) | 22859 | CPT Add On CPT Resequenced MPFS Status: Active Code APC N ASC N1 Insertion of intervertebral biomechanical device(s) (eg, synthetic cage, mesh, methylmethacrylate) to intervertebral disc space or vertebral body defect without interbody arthrodesis, each contiguous defect (List separately in addition to code for primary procedure) | 63308 | Addon Code MPFS Status: Active Code APC C CPT Assistant Article Vertebral corpectomy (vertebral body resection), partial or complete, for excision of intraspinal lesion, single segment; each additional segment (List separately in addition to codes for single segment) | 69990 | Addon Code MPFS Status: Restricted APC N ASC N1 PUB 100 CPT Assistant Article 1Microsurgical techniques, requiring use of operating microscope (List separately in addition to code for primary procedure) |
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| 2013-01-01 | Changed | Short Descriptor changed. |
| Pre-1990 | Added | Code added. |
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