CPT® Code 63706

1. Indications

The procedure for the repair of myelomeningocele is indicated in cases where there is a protrusion of the spinal cord and meninges through a defect in the spine, specifically when the defect is larger than 5 cm in diameter. This condition is typically diagnosed during prenatal imaging or at birth, and it may present with various neurological deficits depending on the level of the defect. The primary goal of the surgical intervention is to protect the exposed neural tissue, prevent infection, and minimize further neurological impairment.

• Protrusion of spinal cord and meninges This condition is characterized by the abnormal displacement of the spinal cord and its protective coverings through an opening in the vertebral column.
• Defect larger than 5 cm The surgical repair is specifically indicated for myelomeningocele defects that exceed 5 cm in diameter, as these larger defects pose greater risks for complications.
• Prevention of infection The procedure aims to cover the exposed neural tissue to reduce the risk of infection, which can lead to severe complications.
• Minimization of neurological impairment Timely surgical intervention is crucial to protect the spinal cord and nerves, thereby reducing the potential for further neurological deficits.

2. Procedure

The surgical procedure for the repair of myelomeningocele involves several critical steps to ensure the safe closure of the defect and protection of the spinal cord.

• Step 1: Incision The surgeon begins by making an incision in the membrane (sac) that covers the spinal cord and meninges. This allows access to the underlying structures and facilitates the drainage of any excess cerebrospinal fluid that may be present.
• Step 2: Drainage of fluid Once the incision is made, any accumulated cerebrospinal fluid is carefully drained to relieve pressure and prepare the area for repair.
• Step 3: Closure of dura mater After drainage, the dura mater, which is the tough outer layer of the meninges, is sutured closed over the spinal cord. This step is crucial for providing a protective barrier for the neural tissue.
• Step 4: Layered skin closure Following the closure of the dura mater, the skin is closed in layers over the protruding meninges, spinal cord, and nerves. This layered approach helps to ensure proper healing and minimizes the risk of complications.
• Step 5: Creation of skin flap (if necessary) In cases where direct closure of the defect is not possible due to the size or condition of the surrounding tissue, a skin flap may be created from adjacent skin on the back or buttocks. This flap is rotated to cover the defect and is sutured to the surrounding tissue to secure it in place.

3. Post-Procedure

Post-procedure care for patients who have undergone myelomeningocele repair includes monitoring for signs of infection, ensuring proper wound healing, and managing any potential complications. Patients may require a stay in a neonatal intensive care unit (NICU) for close observation, especially if they are newborns. Follow-up appointments are essential to assess neurological function and to monitor for any signs of hydrocephalus or other related conditions. Rehabilitation services may also be necessary to support the patient's development and address any mobility or functional challenges that may arise as they grow.