DOCSLIB.ORG

Staged Correction of Severe Thoracic Kyphosis in Patients with Multilevel Osteoporotic Vertebral Compression Fractures

Total Page：16

File Type：pdf, Size：1020Kb

Download full-text PDF Read full-text
Staged Correction of Severe Thoracic Kyphosis in Patients with Multilevel Osteoporotic Vertebral Compression Fractures THIEME 710 Technical Report GLOBAL SPINE JOURNAL Staged Correction of Severe Thoracic Kyphosis in Patients with Multilevel Osteoporotic Vertebral Compression Fractures Eyal Behrbalk1 OfirUri1 Yoram Folman1 Marcus Rickert2 Radek Kaiser2 Bronek Maximilian Boszczyk2 1 The Spine Unit, Hillel-Yaffe Medical Center, Hadera, Israel Address for correspondence Dr. Eyal Behrbalk, The Spine Unit, Hillel- 2 The Centre for Spinal Studies and Surgery, Queen’sMedicalCentre, Yaffe Medical Center, Ha-Shalom Street, Hadera, 38100, Israel Nottingham, United Kingdom (e-mail: [email protected]). Global Spine J 2016;6:710–720. Abstract Study Design Technical report. Objective Multilevel osteoporotic vertebral compression fractures may lead to con- siderable thoracic deformity and sagittal imbalance, which may necessitate surgical intervention. Correction of advanced thoracic kyphosis in patients with severe osteo- porosis remains challenging, with a high rate of failure. This study describes a surgical technique of staged vertebral augmentation with osteotomies for the treatment of advanced thoracic kyphosis in patients with osteoporotic multilevel vertebral compres- sion fractures. Methods Five patients (average age 62 Æ 6 years) with multilevel osteoporotic vertebral compression fractures and severe symptomatic thoracic kyphosis underwent staged vertebral augmentation and surgical correction of their sagittal deformity. Clinical and radiographic outcomes were assessed retrospectively at a mean postoper- ative follow-up of 34 months. Results Patients’ self-reported back pain decreased from 7.2 Æ 0.8 to 3.0 Æ 0.7(0to 10 numerical scale; p < 0.001). Patients’ back-related disability decreased from 60 Æ 10% to 29 Æ 10% (0 to 100% Oswestry Disability Index; p < 0.001). Thoracic kyphosis was corrected from 89 Æ 5 degrees to 40 Æ 4 degrees (p < 0.001), and the Keywords sagittal vertical axis was corrected from 112 Æ 83 mm to 38 Æ 23 mm (p ¼ 0.058). ► thoracic kyphosis One patient had cement leakage without subsequent neurologic deficit. Decreased ► severe osteoporosis blood pressure was observed in another patient during the cement injection. No ► osteoporotic correction loss, hardware failure, or neurologic deficiency was seen in the other patients. fractures Conclusion The surgical technique described here, despite its complexity, may offer a ► deformity correction safe and effective method for the treatment of advanced thoracic kyphosis in patients ► staged procedure with osteoporotic multilevel vertebral compression fractures. Introduction midthoracic vertebrae are the most commonly involved vertebrae, causing a loss of lumbar lordosis and/or increased – Vertebral compression fractures are frequent in patients with thoracic kyphosis, leading to positive sagittal balance.1 3 osteoporosis. The estimated occurrence is 15% in females and Frequent sequelae are back pain, early muscle fatigue, ambu- 5% in males of Caucasian origin.1,2 The thoracolumbar and lation difficulty, and substantial decrease in quality of life.1,4,5 received DOI http://dx.doi.org/ © 2016 Georg Thieme Verlag KG September 5, 2015 10.1055/s-0035-1569460. Stuttgart · New York accepted after revision ISSN 2192-5682. October 5, 2015 published online December 2, 2015 Staged Correction of Severe Thoracic Kyphosis Behrbalk et al. 711 Conservative treatment includes immobilization, analge- the whole spine and pelvis (for assessment of sagittal balance sia, and physiotherapy as well as antiresorptive and anabolic parameters), and magnetic resonance imaging of the whole medications, which may reduce the risk of future fractures spine (►Fig. 1). and kyphosis progression.6,7 If conservative treatment fails, unhealed fractures can be managed surgically by performing Surgical Considerations percutaneous vertebral cement augmentation. Cement injec- Preoperative planning was performed using whole-spine tion may restore vertebral height and provide rapid analgesia unsupported standing radiographs and magnetic resonance – and functional improvement.8 13 However, in the case of imaging. Multiple chevron osteotomies around the apex multiple healed (old) osteoporotic fractures with established vertebra were planned based on deformity shape and the kyphotic deformity and sagittal imbalance, more extensive amount of sagittal balance correction required, assuming intervention may be indicated. correction of 5 to 8 degrees per osteotomy.24 In the cases Several surgical techniques have been described for the of vertebral collapse with a sharp thoracic kyphotic angle, a correction of symptomatic sagittal imbalance in patients with pedicle subtraction osteotomy (PSO) without vertebral body – osteoporosis.12 14 These techniques usually involve lumbar augmentation was planned.24 To minimize the risk of failure subtraction osteotomy with fusion of the construct to the S1 in the osteoporotic spine, the fusion included at least three and the pelvis.15,16 Although effective in restoring sagittal levels above and below the last osteotomized vertebrae to balance, spinal pelvic fusion is associated with a high failure avoid ending the instrumentation at or near a kyphotic rate and the loss of movement in all the lumbar motion segment.20,22,25 Cement augmentation of the vertebrae was segments.17 Moreover, the correction of the sagittal balance performed to increase the pedicle screw pullout strength, alone by lumbar osteotomy does not address the cosmetically restore vertebrae stiffness to its prefractured values, and disturbing thoracic hump. Because pedicle screw loosening prevent new formation of adjacent-level fractures. As stiff- and adjacent-level vertebral body fracture are common ness of the vertebral body is strongly influenced by the among patients with osteoporosis, surgeons tend to avoid volume of cement injected and 14 to 16% of vertebral body – correction of these challenging cases.18 23 volume fill was shown to restore stiffness to the predamaged This study presents our staged surgical correction tech- values, vertebrae bodies were augmented with a minimum of nique and preliminary outcomes in a group of patients whose 6 mL per level of cement in the lumbar vertebrae and a – life quality was severely affected by their thoracic deformity minimum of 4 mL per level in thoracic ones.21,26 28 Augmen- and sagittal imbalance as a result of their multilevel osteopo- tation was performed at all levels involved in the fusion and at rotic vertebral compression fractures. the very least in the first mobile vertebrae below the fusion mass (transition vertebrae are prone to develop new frac- 20–23,28–30 ’ Materials and Methods tures). At the surgeon s discretion, one vertebra may be left uncemented (usually L3 or L4) to allow for future Patient Population PSO. Five patients (two women and three men, average age 62 Æ 6 Several studies showed direct correlation between the years) with multiple osteoporotic vertebral compression volume of cement injection and occurrence of pulmonary fractures (four or five levels involved) and severe symptom- fat emboli and systemic hypotension. To reduce these risks, atic thoracic kyphosis (an average kyphosis of 89 Æ 5de- only 30 mL of cement was injected per procedural stage.31,32 grees) underwent staged surgical correction of their spinal Because fat embolism syndrome can develop 12 to 36 hours deformity, and results were reviewed at a mean of 34 Æ 5 after surgery (e.g., petechial rash, tachypnea, dyspnea, tachy- months (►Table 1). The study was conducted as a retrospec- cardia, pyrexia, oliguria, thrombocytopenia),32,33 we waited tive case series and as such, Institutional Review Board at least 3 days before proceeding with the next stage. Aug- approval was not needed. The indications for surgery were mentation of several vertebrae per stage may be a prolonged back pain with severe thoracic deformity causing sagittal procedure, thus we preferred to perform vertebral augmen- imbalance and related disability (difficulty in ambulation tation under general anesthesia rather than sedation. The and in activities of daily living) and evidence of kyphosis number of stages required was based on the patients’ medical progression due to new osteoporotic fractures seen on con- condition to withstand a long operation and on the number of secutive radiographs. For all patients, pain and disability did vertebrae needed to be augmented before the final deformity not diminish with nonoperative treatment over a period of at correction. Between stages, the patients were discharged least 12 months. None had a neurologic deficit. All had severe home (apart from patient 1 who remained in the hospital osteoporosis (an average T-score of À3.2 Æ 0.3, range À2.8 to between his third and forth stages). A detailed description of À3.6) secondary to long-standing corticosteroid use, which the surgical steps for each patient is presented in ►Table 2. was prescribed as an adjunct to chemotherapy for two The pros and cons of a staged procedure, including the patients with multiple myeloma and as immunotherapy for risks of repeated anesthesia, long operations, and reopening three patients (two with rheumatoid arthritis and one with the same surgical wound, were discussed thoroughly with the inflammatory bowel disease). The preoperative assessment patients preoperatively. All of the patients understood the included a detailed physical examination, dual-energy X-ray complexity of the procedure and the involved risks. Never- absorptiometry scan for bone density measurement, stand- theless, due to the severity of their
Load more

Recommended publications
  • Post–Vertebral Augmentation Back Pain: ORIGINAL RESEARCH Evaluation and Management
    Post–Vertebral Augmentation Back Pain: ORIGINAL RESEARCH Evaluation and Management S. Kamalian BACKGROUND AND PURPOSE: Vertebral augmentation is an established treatment for painful osteo- R. Bordia porotic vertebral fractures of the spine. Nevertheless, patients may continue to have significant back pain afterward. The purpose of this study was to assess the source of persistent or recurrent back pain A.O. Ortiz following vertebral augmentation. MATERIALS AND METHODS: Our institutional review board approved this study. We evaluated 124 consecutive patients who underwent vertebral augmentation for painful osteoporotic vertebral frac- tures. All patients were evaluated after 3 weeks, 3 months, and 1 year following their procedure. Patients with any type of back pain after their procedure were examined under fluoroscopy. RESULTS: Thirty-four of 124 (27%) patients were men, and 90/124 (73%) were women. Persistent or recurrent back pain, not due to a new fracture or a failed procedure, was present in 29/124 (23%) patients. The source of pain was most often attributed to the sacroiliac and/or lumbar facet joints (25/29 or 86%). Seventeen of 29 (59%) patients experienced immediate relief after facet joint injection of a mixture of steroid and local anesthetic agents. The remaining 12 (41%) had relief after additional injections. Ten (34%) patients ultimately required radio-frequency neurolysis for long-term relief. CONCLUSIONS: Back pain after vertebral augmentation may not be due to a failed procedure but rather to an old or a new pain generator, such as an irritated sacroiliac or lumbar facet joint. This is of importance not only for further pain management of these patients but also for designing trials to compare the efficacy of vertebral augmentation to other treatments.
    [Show full text]
  • Procedure Codes
    NEW YORK STATE MEDICAID PROGRAM ORDERED AMBULATORY PROCEDURE CODES Ordered Ambulatory Procedure Codes Table of Contents GENERAL INFORMATION ---------------------------------------------------------------------------------------------------------------2 LABORATORY SERVICES INFORMATION-----------------------------------------------------------------------------------------2 RADIOLOGY INFORMATION------------------------------------------------------------------------------------------------------------3 MMIS MODIFIERS --------------------------------------------------------------------------------------------------------------------------6 RADIOLOGY SERVICES------------------------------------------------------------------------------------------------------------------7 DIAGNOSTIC RADIOLOGY (DIAGNOSTIC IMAGING) ------------------------------------------------------------------------7 DIAGNOSTIC ULTRASOUND SERVICES- -------------------------------------------------------------------------------------- 20 RADIOLOGIC GUIDANCE....................................................................................................................................25 BREAST, MAMMOGRAPHY --------------------------------------------------------------------------------------------------------- 26 BONE/JOINT STUDIES --------------------------------------------------------------------------------------------------------------- 26 RADIATION ONCOLOGY SERVICES --------------------------------------------------------------------------------------------- 27 NUCLEAR
    [Show full text]
  • Vertebral Augmentation ICD 9 Codes: Osteoporosis 733. 0, Vertebra
    BRIGHAM AND WOMEN’S HOSPITAL Department of Rehabilitation Services Physical Therapy Standard of Care: Vertebral Augmentation ICD 9 Codes: Osteoporosis 733. 0, Vertebral Fracture closed 805.8, Pathological fracture of Vertebrae 733.13 Vertebral augmentation, known as vertebroplasty and kyphoplasty, is a minimally invasive procedure that is used to treat vertebral fractures. Vertebral fractures are the most common skeletal injury associated with osteoporosis, and it is estimated that more than 750,000 occur annually in the United States.1 Up to one quarter of people over 50 years of age will have at least one vertebral fracture in their life time secondary to osteoporosis.2 According to the World Health Organization (WHO), the operational definition of osteoporosis is a bone density measure >2.5 standard deviations (SD) below the mean of young healthy adults of similar race and gender.3 Primary osteoporosis is related to the changes in postmenopausal women secondary to reduction of estrogen levels and related to age-related loss of bone mass. Secondary osteoporosis is the loss of bone caused by an agent or disease process. 1,4 (See Osteoporosis SOC) The severity of vertebral fractures can be assessed by the Genat semiquantitative method. Commonly used by radiologists, this scale assesses the severity of the fracture visually and has been shown to be reliable.5 Genat Semiquantitive Grading System for Vertebral Deformity5 Grade 0- normal vertebral height Grade 1- minimal fracture- 20-25% height decrease Grade 2- moderate fracture- 25-40% height decrease Grade 3-severe- >40% height decrease Standard methods of diagnosing vertebral fractures are imaging, including the following: CT scan, MRI, and radiography.
    [Show full text]
  • Musculoskeletal Program CPT Codes and Descriptions
    Musculoskeletal Program CPT Codes and Descriptions Spine Surgery Procedure Codes CPT CODES DESCRIPTION Allograft, morselized, or placement of osteopromotive material, for spine surgery only (List separately in addition 20930 to code for primary procedure) 20931 Allograft, structural, for spine surgery only (List separately in addition to code for primary procedure) Autograft for spine surgery only (includes harvesting the graft); local (eg, ribs, spinous process, or laminar 20936 fragments) obtained from same incision (List separately in addition to code for primary procedure) Autograft for spine surgery only (includes harvesting the graft); morselized (through separate skin or fascial 20937 incision) (List separately in addition to code for primary procedure) Autograft for spine surgery only (includes harvesting the graft); structural, bicortical or tricortical (through separate 20938 skin or fascial incision) (List separately in addition to code for primary procedure) 20974 Electrical stimulation to aid bone healing; noninvasive (nonoperative) Osteotomy of spine, posterior or posterolateral approach, 3 columns, 1 vertebral segment (eg, pedicle/vertebral 22206 body subtraction); thoracic Osteotomy of spine, posterior or posterolateral approach, 3 columns, 1 vertebral segment (eg, pedicle/vertebral 22207 body subtraction); lumbar Osteotomy of spine, posterior or posterolateral approach, 3 columns, 1 vertebral segment (eg, pedicle/vertebral 22208 body subtraction); each additional vertebral segment (List separately in addition to code for
    [Show full text]
  • Effectiveness of Cementoplasty for Vertebral Augmentation in Multiple Myeloma: a Case Series
    WCRJ 2017; 4 (2): e882 EFFECTIVENESS OF CEMENTOPLASTY FOR VERTEBRAL AUGMENTATION IN MULTIPLE MYELOMA: A CASE SERIES G. TESTA1, M. PRIVITERA1, T. FIDILIO1, G. DI STEFANO1, A. VESCIO1, G. D’ANGELO2, V. PAVONE1 1Department of Orthopedics and Traumatologic Surgery, AOU Policlinico-Vittorio Emanuele, University of Catania, Catania, Italy 2Department of Human Pathology in Adult and Developmental Age “Gaetano Barresi” – Unit of Paediatrics, University of Messina, Messina, Italy Abstract – Objective: Multiple myeloma (MM) is a neoplasm characterized by the proliferation of somatically mutated plasma cells that tend to expand within the bone marrow and affect mul- tiple locations throughout the bone marrow. When it is located in vertebral areas it causes bone lesions with pain, kyphosis, walking impairments, and disability. Different types of treatments are available. The goal of this study is to report our experience regarding the treatment of vertebral fractures from multiple myeloma using cementoplasty. Patients and Methods: From January 2012 to December 2015, 38 patients with multiple mye- loma and multilevel vertebral fractures were treated. Seventeen patients underwent conservative treatment (group 1), and 21 patients underwent vertebral augmentation with percutaneous ce- mentoplasty (group 2). Both groups were clinically evaluated at 1, 6 and 12 months using a visual analogic scale (VAS) for pain, SF-36 and ODI Score Questionnaires. Radiographic evaluation was performed to verify the quality of cementoplasty and complications. Results: Mean follow-up was 23.7 months. Mean VAS score in group 1 decreased from 7.1 pre-operatively to 3.9 at final follow-up (p<0.05). In group 2, this score decreased from 7.3 pre-op- eratively to 2.3 at final follow-up (p<0.05).
    [Show full text]
  • Vertebroplasty and Percutaneous Vertebral Augmentation
    Medicare Part C Medical Coverage Policy Vertebroplasty and Percutaneous Vertebral Augmentation Origination Date: December 16, 2002 Vertebroplasty August 20, 2003 Kyphoplasty Review Date: June 17, 2020 Next Review: June, 2022 ***This policy applies to all Blue Medicare HMO, Blue Medicare PPO, Blue Medicare Rx members, and members of any third-party Medicare plans supported by Blue Cross NC through administrative or operational services. *** DESCRIPTION OF PROCEDURE OR SERVICE Vertebroplasty Percutaneous vertebroplasty is a therapeutic, interventional radiologic procedure, which consists of the injection of a biomaterial (usually polymethylmethacrylate- bone cement) under imaging guidance (either fluoroscopy or CT) into a cervical, thoracic or lumbar vertebral body lesion for the relief of pain and the strengthening of bone. Percutaneous Vertebral Augmentation This is also known as balloon-assisted Percutaneous Vertebroplasty or Kyphoplasty. The procedure is similar to percutaneous vertebroplasty in that stabilization of the collapsed vertebra is accomplished by the injection of the same biomaterial into the body of the vertebra. The primary difference is that the fracture is partially reduced with the insertion of an inflatable balloon tamp. Once inflated, the balloon tamp (plug) restores some height to the vertebral body, while creating a cavity that is filled with bone cement. POLICY STATEMENT Coverage will be provided for vertebroplasty or percutaneous vertebral augmentation when it is determined to be medically necessary because the
    [Show full text]
  • A Novel and Convenient Method to Evaluate Bone Cement Distribution Following Percutaneous Vertebral Augmentation
    www.nature.com/scientificreports OPEN A novel and convenient method to evaluate bone cement distribution following percutaneous vertebral augmentation Jin Liu1,2,4, Jing Tang3,4, Hao Liu1*, Zuchao Gu2, Yu Zhang2 & Shenghui Yu2 A convenient method to evaluate bone cement distribution following vertebral augmentation is lacking, and therefore so is our understanding of the optimal distribution. To address these questions, we conducted a retrospective study using data from patients with a single-segment vertebral fracture who were treated with vertebral augmentation at our two hospitals. Five evaluation methods based on X-ray flm were compared to determine the best evaluation method and the optimal cement distribution. Of the 263 patients included, 49 (18.63%) experienced re-collapse of treated vertebrae and 119 (45.25%) experienced new fractures during follow-up. A 12-score evaluation method (kappa value = 0.652) showed the largest area under the receiver operating characteristic curve for predicting new fractures (0.591) or re-collapse (0.933). In linear regression with the 12-score method, the bone cement distribution showed a negative correlation with the re-collapse of treated vertebra, but it showed a weak correlation with new fracture. The two prediction curves intersected at a score of 10. We conclude that an X-ray-based method for evaluation of bone cement distribution can be convenient and practical, and it can reliably predict risk of new fracture and re-collapse. The 12-score method showed the strongest predictive power, with a score of 10 suggesting optimal bone cement distribution. Since Galibert and Deramond frst used bone cement to treat aggressive cervical hemangiomas in 19871, this procedure has been verifed by numerous studies to be an efective minimally invasive surgery for the treatment of osteoporotic vertebral compression fractures (OVCFs)2–5.
    [Show full text]
  • Vertebral Augmentation Involving Vertebroplasty Or Kyphoplasty for Cancer-Related Vertebral Compression Fractures: a Systematic Review
    Health Quality Ontario The provincial advisor on the quality of health care in Ontario ONTARIO HEALTH TECHNOLOGY ASSESSMENT SERIES Vertebral Augmentation Involving Vertebroplasty or Kyphoplasty for Cancer-Related Vertebral Compression Fractures: A Systematic Review KEY MESSAGES Cancer can start in one part of the body and spread to other regions, often involving the spine, causing significant pain and reducing a patient’s ability to walk or carry out everyday activities such as bathing, dressing, and eating. When cancer spreads to or occurs in a bone of the spine (a vertebral bone), the cancer can weaken and break this bone. These fractures, if left untreated, can negatively affect the quality of life of terminally ill patients and their families. Vertebroplasty and kyphoplasty are two types of procedures called vertebral augmentation. During vertebral augmentation, the physician injects bone cement into the broken vertebral bone to stabilize the spine and control pain. Kyphoplasty is a modified form of vertebroplasty in which a small balloon is first inserted into the vertebral bone to create a space to inject the cement; it also attempts to lift the fracture to restore it to a more normal position. Medical therapy and bed rest are not very effective in cancer patients with painful vertebral fractures, and surgery is not usually an option for patients with advanced disease and who are in poor health. Vertebral augmentation is a minimally invasive treatment option, performed on an outpatient basis without general anesthesia, for managing painful vertebral fractures that limit mobility and self-care. We reviewed the evidence to evaluate the safety and effectiveness of vertebroplasty and kyphoplasty in cancer patients.
    [Show full text]
  • Stabilit™ Vertebral Augmentation System Redefining the Treatment Of
    You would never guess that Janice had a Vertebral Compression Fracture. StabiliT™ For information about the StabiliT™ Vertebral Augmentation System, Vertebral Augmentation System Please visit www.dfineinc.com, or consult with your physician today. Redefining the treatment of Vertebral Compression Fractures 3047 Orchard Parkway San Jose, CA 95134 Tel: 1-866-96DFINE (1.866.963.3463) Fax: 408.321.9401 Email: [email protected] ©2008 DFine Inc. All rights reserved. PML1233-AA (09-2008) What is a Vertebral Compression Fracture? How the StabiliT™ Vertebral Augmentation StabiliT™ Vertebral Augmentation System System Works The spine is made up of a series of strong bones Redefining the treatment of Vertebral called vertebrae. A vertebra can break just like any StabiliT™ Vertebral Augmentation System is a Compression Fractures other bone in the body. When the vertebral body minimally invasive solution for treating vertebral The goal in treating a vertebral compression collapses, it is called a vertebral compression compression fractures of the spine to ease pain fracture is to stabilize it, reduce pain, return to and improve strength and stability of the fracture (VCF). normal function and prevent any spinal deformity. vertebral body. The StabiliT™ Vertebral Augmentation System This procedure is performed at a hospital under stabilizes the spine while providing patients with One fracture significantly local or general anesthesia. After making a small much needed pain relief. After treatment, studies increases the risk of incision, a small instrument is guided into the of minimally invasive vertebral augmentation another, causing spinal collapsed vertebra. procedures have shown: deformity and an overall decrease in health. VCFs are painful, sometimes • Relief of back pain and discomfort1 progressive and reduce • Potential correction of spinal deformity2 the patient’s quality of life.
    [Show full text]
  • Spinal Surgery Coding Pain Coding
    Spinal Surgery coding Pain Coding CASE STUDIES, DISCUSSION ROBIN INGALLS-FITZGERALD, CCS, CPC, FCS, CEDC, CEMC CEO/PRESIDENT MEDICAL MANAGEMENT AND REIMBURSEMENT SPECIALISTS, LLC Agenda Discuss spinal procedures CPT PCS And more Spinal Fusions- PCS coding Some of the most complex surgeries to code in ICD-10 Spinal fusion is classified by the anatomic portion (column) fused and the technique (approach) used to perform the fusion. The fusion can include a discectomy, bone grafting, and spinal instrumentation. Spinal Fusions Anterior Column: The body (corpus) of adjacent vertebrae (interbody fusion). The anterior column can be fused using an anterior, lateral, or posterior technique. Posterior Column: Posterior structures of adjacent vertebrae (pedicle, lamina, facet, transverse process, or “gutter” fusion). A posterior column fusion can be performed using a posterior, posterolateral, or lateral transverse technique. Approaches: Posterior or from the back (most common); anterior through a laparotomy Spinal Anatomy Devices Interbody fusion devices —e.g. BAK cages, PEEK cages, bone dowels Autologous Tissue Substitute —bone graft obtained from the patient during the procedure. Bone grafts may be harvested locally using the same incision, or from another part of the body requiring a separate incision. Harvesting requires a separate procedure code ONLY when it is performed through a separate incision. Nonautologous Tissue Substitute —bone bank Synthetic Substitute —examples include demineralized bone matrix, synthetic bone graft extenders, bone morphogenetic proteins (BMP) Interbody Fusion Devices The interbody fusion device immobilizes the intervertebral joint to stabilize the segment for fusion. It restores disc space height and requires removal of all or part of the disc so that the device can be inserted into the disc space.
    [Show full text]
  • Kyphoplasty/Vertebroplasty, Thoracic Spine
    Musculoskeletal Surgical Services: Spine Fusion/Stabilization Surgery; Kyphoplasty/Vertebroplasty, Thoracic Spine POLICY INITIATED: 06/30/2019 MOST RECENT REVIEW: 06/30/2019 POLICY # HH-5641 Overview Statement The purpose of these clinical guidelines is to assist healthcare professionals in selecting the medical service that may be appropriate and supported by evidence to improve patient outcomes. These clinical guidelines neither preempt clinical judgment of trained professionals nor advise anyone on how to practice medicine. The healthcare professionals are responsible for all clinical decisions based on their assessment. These clinical guidelines do not provide authorization, certification, explanation of benefits, or guarantee of payment, nor do they substitute for, or constitute, medical advice. Federal and State law, as well as member benefit contract language, including definitions and specific contract provisions/exclusions, take precedence over clinical guidelines and must be considered first when determining eligibility for coverage. All final determinations on coverage and payment are the responsibility of the health plan. Nothing contained within this document can be interpreted to mean otherwise. Medical information is constantly evolving, and HealthHelp reserves the right to review and update these clinical guidelines periodically. No part of this publication may be reproduced, stored in a retrieval system or transmitted, in any form or by any means, electronic, mechanical, photocopying, or otherwise, without permission
    [Show full text]
  • Spinal Instrumentation Rescue with Cement Augmentation
    Published September 13, 2018 as 10.3174/ajnr.A5795 ORIGINAL RESEARCH SPINE Spinal Instrumentation Rescue with Cement Augmentation X A. Cianfoni, X M. Giamundo, X M. Pileggi, X K. Huscher, X M. Shapiro, X M. Isalberti, X D. Kuhlen, and X P. Scarone ABSTRACT BACKGROUND AND PURPOSE: Altered biomechanics or bone fragility or both contribute to spine instrumentation failure. Although revision surgery is frequently required, minimally invasive alternatives may be feasible. We report the largest to-date series of percuta- neous fluoroscopically guided vertebral cement augmentation procedures to address feasibility, safety, results and a variety of spinal instrumentation failure conditions. MATERIALS AND METHODS: A consecutive series of 31 fluoroscopically guided vertebral augmentation procedures in 29 patients were performed to address screw loosening (42 screws), cage subsidence (7 cages), and fracture within (12 cases) or adjacent to (11 cases) the instru- mented segment. Instrumentation failure was deemed clinically relevant when resulting in pain or jeopardizing spinal biomechanical stability. The main study end point was the rate of revision surgery avoidance; feasibility and safety were assessed by prospective recording of periprocedural technical and clinical complications; and clinical effect was measured at 1 month with the Patient Global Impression of Change score. RESULTS: All except 1 procedure was technically feasible. No periprocedural complications occurred. Clinical and radiologic follow-up was available in 28 patients (median, 16 months) and 30 procedures. Revision surgery was avoided in 23/28 (82%) patients, and a global clinical benefit (Patient Global Impression of Change, 5–7) was reported in 26/30 (87%) cases at 1-month follow-up, while no substantial change (Patient Global Impression of Change, 4) was reported in 3/30 (10%), and worsening status (Patient Global Impression of Change, 3), in 1/30 (3%).
    [Show full text]