Osteotomy spine fusion. The procedure involves careful .
Osteotomy spine fusion. . Cervical and lumbar spine osteotomies are surgical procedures that can be very helpful in treating spinal deformities. CPT is a registered trademark of the American Medical Association. As such, the root operation for osteotomy for spinal deformity is Reposition. Pedicle subtraction osteotomy (PSO) is highly effective as a sagittal correction approach in patients with adult spinal deformity, but relevant issues such as surgical complexity and long-term complications limit its applicability. Jun 17, 2024 · Provides an overview of several spinal procedures, such as scoliosis ICD 10 codes, cervical spinal fusion, fasciotomy, & osteotomy surgery. Abstract Introduction: Flat-back syndrome is one of the main causes of surgical failure after lumbar fusion and can lead to a revision surgery to correct it. But spine procedure coding doesn’t have to be difficult. Jason Lowenstein, MD is an industry leading expert in PCO & Spinal Deformity Correction! Review procedure details, benefits, & eligibility requirements from a master in his field! The aims of spinal deformity surgery are to achieve bal-ance, relieve pain and prevent recurrence or worsening of the deformity. Patients with spinal instability or chronic back pain may require anterior or posterior lumbar spinal fusion surgery (less commonly referred to as spinal fusion with instrumentation). In adolescent idiopathic scoliosis, the primary surgery used today is fusion surgery. In stiff and ankylosed cervical spines, osteotomies Sep 15, 2023 · Three-column spinal osteotomies (3-CO) are powerful techniques used to correct spinal deformity. The three columns referred to in three column osteotomies are the anterior, middle, and posterior columns of the spine. Intraoperative neuromonitoring (IONM) was utilized for all patients to ensure neurologic safety during surgery. ** The coding information and guidance are valid at the time of publishing. Osteotomy on the L1 vertebra (additional vertebral segment). The fusion mass stemming from the past surgeries makes the procedure demanding as most anatomical Apr 27, 2017 · The aims of spinal deformity surgery are to achieve balance, relieve pain and prevent recurrence or worsening of the deformity. Do you need a Posterior Column Osteotomy (PCO) to correct an abnormal curvature of the spine? Dr. g. Demographics, imaging, and Conclusion: Spinous process osteotomy also minimizes tissue injury by preserving the paraspinal musculature and the interspinous, supraspinous ligament complex, and facets. 4: Initial Primary Posterior Cervical Fusion with Posterior Cervical Decompression for Conditions other than Pseudoarthrosis CMM-604. Jan 24, 2022 · In our discussion on osteotomies for correction of spinal deformities, the intent of the osteotomy procedure is to bring the spine into proper alignment. The procedure aims to induce proper and The scenario above describes seven levels of posterior osteotomies, mainly in the thoracic area, which would support code 22212 (Osteotomy of spine, posterior or posterolateral approach, 1 vertebral segment; thoracic) and six units of add-on code +22216 (each additional vertebral segment). Dec 6, 2023 · Don’t Forget Arthrodesis No matter the situation, your surgeon will have to wrap up an osteotomy with arthrodesis to fuse the resected area of the spine. Gupta, MD Professor of Orthopedic surgery Chief of Spine Service of California, Davis Sacramento, California This subclassification ofPSOsrepresentsacatalogueoftheavailablespinal osteotomies, betweenaposterior column osteotomyanda vertebral col-umn resection,thatwouldhelpsurgeonsin their decision totailorthe type of osteotomy according to the encountered spinal condition. Method The medical records and imaging data of degenerative scoliosis patients in our department from 2013 to 2022 were retrospectively collected. Our better understanding of alignment biomechanics, and the progressive refinements of the surgical technique over time made it a very efficient procedure for the management of fixed sagittal malalignment. One of the main focuses of the osteotomy procedure is to restore sagittal harmony, or the “front-to-back” balance of the spine. They can be performed on pediatric or adult patients. This procedure allows for realignment of the spine, improving posture and relieving nerve compression. The type of osteotomy used depends on both the location of the spinal deformity and on the amount of correction that is required. Most procedures that treat spinal deformity are technically types of osteotomy. Different types of 3-column osteotomies (3COs), including Schwab 3, Schwab 4, Schwab 4 with interbody cages, and the Mar 23, 2021 · Q: Can we code Smith Peterson osteotomy separately with spinal deformity fusion? A: Osteotomy procedures performed to realign the spine in spinal deformities (e. (Report in addition to code[s] for the definitive procedure with modifier Jan 1, 2014 · The surgical solutions usually involve a combination of osteotomies through the fusion mass and extension of the fusion to include degenerated segments. This configuration holds your spine correction in place until the vertebrae fuse together into the corrected position. Oct 1, 2016 · Rigid cervical deformities are difficult problems to treat. Another technicaldetailregardingthePSOistheuseofacageinside the PSO site. Oct 1, 2015 · Discover comprehensive information about ICD-10-PCS code 0RG60AJ - Fusion of Thoracic Vertebral Joint with Interbody Fusion Device, Posterior Approach, Anterior Column, Open Approach Pseudarthrosis after spinal fusion Pseudarthrosis following spinal fusion Pseudoarthrosis Pseudoarthrosis of spine Pseudoarthrosis spine ICD-10-CM M96. Dec 1, 2023 · Three-Column Osteotomies (3CO's) refer to osteotomies that involve surgical removal of parts or all of the posterior, middle and anterior columns of the spine. The decision-making process should address the timing of the surgery, surgical approach, level of interbody fusion required, correction of sagittal imbalance, type of osteotomy, location of the osteotomy, and the end of the construct. 3: Initial Primary Posterior Cervical Fusion for Conditions other than Pseudoarthrosis CMM-604. What is a Pedicle Subtraction Osteotomy? Pedicle Subtraction Osteotomy is a surgical procedure performed on the spine to correct severe spinal deformities, such as excessive kyphosis or scoliosis. The three main types of osteotomy are: Smith-Petersen osteotomy (SPO): SPO is recommended for relatively small corrections (approximately 10-20° for each level). The three main types of osteotomy are: Smith-Petersen Osteotomy (SPO): SPO is recommended in patients in whom a relatively small amount of correction (approximately 10-20° for each level) is required. 1: General Guidelines CMM-604. Why Spinal Osteotomy Surgery? One of the most common reasons for an individual to undergo a Spinal Osteotomy procedure has got to be in an effort to correct certain spinal deformities or curvature issues, such as scoliosis or kyphosis. Dec 23, 2024 · BACKGROUND Adult spinal reconstructive surgery that requires multilevel spinal fusion is highly invasive and requires two-stage surgery using lateral lumbar interbody fusion (LLIF) and/or percutaneous pedicle screw (PPS) fixation to make it less invasive. Sep 7, 2022 · Code posterior column osteotomies with codes from the 22210 (Osteotomy of spine, posterior or posterolateral approach, 1 vertebral segment; cervical) through +22216 (Osteotomy of spine, posterior or posterolateral approach, 1 vertebral segment; each additional vertebral segment (List separately in addition to primary procedure)) code set. Recently, minimally invasive techniques have been reported to be useful for surgical treatment of adult spinal deformity; however, few reports have directly A spinal fusion with instrumentation may also be performed along with spine osteotomy to stabilize the spine and prevent further curvature. By addressing all three columns, surgeons can achieve comprehensive correction of the spinal deformity. Learn about its types, symptoms, causes, diagnosis, and recovery process. The main types of osteotomies are the Smith-Petersen osteotomy (SPO), pedicle subtraction osteotomy (PSO), bone-disc-bone See full list on scoliosissos. What if we used navigation to place screws? Jul 9, 2025 · Surgical options for AS include laminectomy, spinal osteotomy, spinal fusion, and hip joint replacement, each addressing specific issues caused by the condition. It aims to correct the deformity of the spinal curve with the goal of relieving pain and other associated symptoms. Correct selection of fusion levels in surgical planning for the management of adult spinal deformity Feb 24, 2011 · Patient is having a lumbar pedicle subtraction osteotomy and fusion to correct the abnormality and spinal alignment. The three main types of osteotomy are: Spine osteotomies can be broadly divided into three main types. A spinal osteotomy is a surgical procedure used to correct certain deformities of the adult or pediatric spine. Jul 15, 2025 · Single-level disc degeneration Patients without significant spinal instability or arthritis Younger individuals seeking to maintain motion and avoid fusion Compared to spinal fusion, ADR can reduce the risk of adjacent segment disease, which is degeneration in neighboring spinal levels. McCormickPedicle Subtraction Osteotomy Oct 23, 2024 · CMM-604: Posterior Cervical Fusion CMM-604. Report arthrodesis with spinal osteotomy with codes from the 22590 (Arthrodesis, posterior 1 day ago · Long-segment spinal fusion and osteotomy are among the most challenging surgeries for treating spinal deformities. These surgeries are associated with an elevated risk of complications. Spine osteotomies also prevent the curvature from worsening in the future. Purpose We compared four different osteotomies and assessed complication rates in adult patients who underwent spinal fusion using a large multi-institutional database. Managing neuromuscular scoliosis with osteotomy means thinking carefully about how the other health problem is changing and how that affects the patient’s overall health. However, it is still difficult to make spinal osteotomy less invasive, and the high complication rate is an issue. A spinal osteotomy is a crucial procedure aimed at correcting spinal deformities. It is designed simply as a resource to help you obtain a better understanding of spine coding. The main types of osteotomies are the Smith-Petersen osteotomy (SPO), pedicle subtraction osteotomy (PSO), bone-disc-bone osteotomy (BDBO) and vertebral column resection (VCR), in order of increasing complexity. CPT® Assistant (January 2001, page 12) states that these codes can be reported in addition to the fusion code if performed for decompression (apply modifier -59 to the decompression code). Sep 1, 2024 · Pedicle subtraction osteotomy has been thoroughly described and studied over the past 2 decades, being applied mainly in the lumbar spine, followed by the thoracic spine. The medical records and imaging data of Aug 3, 2025 · A T10-pelvis fusion and an Posterior column osteotomies? About a month ago, I saw a surgeon in NYC who was one of the first to use a robotic arm in spine surgery. The goals of surgical treatment include deformity correction, achieving a rigid fusion, and performing a thorough neural decompression. Spinal osteotomies are surgical procedures that doctors use to treat a wide variety of spinal deformities. 0 is grouped within Diagnostic Related Group (s) (MS-DRG v43. The main types of osteotomies are the Smith-Petersen osteotomy (SPO), pedicle subtraction osteotomy (PSO), bone-disc-bone osteotomy (BDBO) and vertebral column resection (VC … Adult spinal deformity (ASD) is one of the most challenging spinal disorders associated with broad range of clinical and radiological presentation. In this surgery, metal implants are attached to the spine and then connected to a single rod or 2 rods. A total of 47 patients were included Jan 27, 2025 · Osteotomy techniques employed included pedicle subtraction osteotomy (PSO) or corner osteotomy. Learners are encouraged to research subsequent official guidance in the areas associated with the topic as they can change rapidly. Alternative techniques with reduced risk are needed. Adult spinal reconstructive surgery that requires multilevel spinal fusion is highly invasive and requires two-stage surgery using lateral lumbar interbody fusion (LLIF) and/or percutaneous pedicle screw (PPS) fixation to make it less invasive. Due to the distorted anatomy care must be taken to confirm correct fusion levels. Do you need a Pedicle Subtraction Osteotomy (PSO) to correct an abnormal curvature of the spine? Dr. May 31, 2024 · Purpose To compare surgical outcomes of Ponte’s osteotomies for treatment of adolescent idiopathic scoliosis (AIS), Scheuermann’s kyphosis (SK), and adult scoliosis (AdS). The surgeon only dictates posterior The incidence of patients requiring lumbar corrective osteotomy for post-fusion lumbar flatback deformity with sagittal imbalance is increasing as the numbers of spine fusion surgeries and overall average life expectancy increases 12). These surgeries require extensive soft tissue and muscle dissection and bone The scenario above describes seven levels of posterior osteotomies, mainly in the thoracic area, which would support code 22212 (Osteotomy of spine, posterior or posterolateral approach, 1 vertebral segment; thoracic) and six units of add-on code +22216 (each additional vertebral segment). NOTE: CPT codes 63030 and 63047 are bundled per National Correct Coding Initiative (NCCI) edits with code 22630. Find out more about this procedure. Sep 23, 2025 · Your guide to scoliosis surgery: An easy-to-read overview of spinal fusions, adjustable growing rods, fusionless growth modulation systems, & osteotomies. It is accomplished by Study design: Retrospective cohort study. He also treas spinal deformity and spinal fusion. Background: PSO and ALIF/LLIF are 2 techniques used to restore lumbar lordosis and correct sagittal alignment, with each The purpose of the study was to evaluate the clinical efficacy and safety of using Ponte osteotomy combined with posterior lumbar interbody fusion in the treatment of patients with degenerative scoliosis. Sep 20, 2024 · Correcting sagittal malalignment in adult spinal deformity (ASD) is a challenging task, often requiring complex surgical interventions like pedicle subtraction osteotomies (PSOs). Spinal fusion surgery is a common treatment for such spinal disorders as spondylolisthesis, scoliosis, severe disc degeneration or spinal fractures. What if we used navigation to place screws? The type of osteotomy used depends on both the location of the spinal deformity and on the amount of correction that is required. Pedicle Subtraction Osteotomy (PSO) is the surgical resection of a wedge section of the vertebra to provide correction of kyphotic deformities. Recently, minimally invasive techniques have been reported to be useful for surgical treatment of adult spinal deformity; however, few reports have directly Multilevel spinal fusion addresses low back pain by stabilizing multiple vertebrae, aiding fusion and enhancing spinal alignment. It involves removing a wedge-shaped section of bone from the vertebral body and posterior elements to realign the spine into a more normal position. Why does it state in CPT under the Osteotomy header, "To report arthrodesis, see codes 22590-22632. This surgical procedure is crucial for correcting spinal deformities and realigning the spine by making a bony incision in the lumbar vertebrae, which are the bones located in the lower back. Pedicle Subtraction Osteotomies : A Useful Tool in Revision of Adult Spinal Deformities Munish C. Methods We conducted a retrospective review of patients with AIS, SK, and AdIS who underwent posterior spinal instrumented fusion (PSIF) at our Institution from January 2019 to December 2022. Oct 25, 2023 · Scenario: Applying CPT Code 22216 in Action A patient with severe scoliosis (curvature of the spine) undergoes a complex surgery. Always refer back to the full Current Procedural Terminology (CPT) book The aims of spinal deformity surgery are to achieve balance, relieve pain and prevent recurrence or worsening of the deformity. The main types of osteotomies are the Smith-Petersen osteotomy (SPO), pedicle subtraction osteotomy (PSO), bone-disc-bone osteotomy (BDBO) and vertebral column resection (VCR), in order of increasing complexity. Apr 5, 2022 · An osteotomy is a bone-cutting procedure to realign and reshape your bones and joints. Dr Anuj Patel in Atlanta and Marietta, GA offers spine osteotomy. They are performed in conjunction with spinal fusion to provide stability and proper alignment of the spine. Objective: The aim of this study was to compare the outcomes of pedicle subtraction osteotomy (PSO) with multilevel anterior lumbar interbody fusion (ALIF) and lateral lumbar interbody fusion (LLIF) in posterior long-segment fusion. The spine surgeon performs the following procedure: Initial osteotomy on the T12 vertebra (vertebral segment). The usual goal is to normalize the regional segmental spinal alignment as much as possible and to achieve global balance. General posterior osteotomies described in order of magnitude of desired correction are: the Smith Peterson Osteotomy [SPO], the pedicle subtraction osteotomy [PSO], and Vertebral Column Resection [VCR], with several underlying variations. Spinous process osteotomy is a modality of treatment for high lumbar disc disease in young patients without the need for spinal fusion. CPT 22214 refers to the osteotomy of the spine, specifically performed through a posterior or posterolateral approach on one vertebral segment in the lumbar region. Spinal deformities can develop for various reasons, and their symptoms can be painful, embarrassing, or debilitating. Sep 29, 2021 · How do lumbar discectomy and spinal fusion differ? While a lumbar spinal fusion can stabilize the spine and reduce pain from a herniated disc, lumbar discectomy is the most common surgical approach because it’s less invasive than a fusion, preserves movement, has a shorter recovery period, and is associated with fewer complications. Feb 16, 2025 · For these cases, osteotomy is often done along with spinal fusion to help stabilize the spine and improve balance. In high grades it recommended to span the fusion from L4 to S1 or pelvis. The chevron osteotomy is called a Smith-Petersen osteotomy if performed through a prior fusion or a Ponté osteotomy if done through a nonfused spinal segment. This manuscript will focus on the past and Nov 28, 2023 · Purpose The purpose of the study was to evaluate the clinical efficacy and safety of using Ponte osteotomy combined with posterior lumbar interbody fusion in the treatment of patients with degenerative scoliosis. , kyphosis, scoliosis) are coded separate from spinal fusions. Paul C. Jason Lowenstein, MD is an industry leading expert in PSO & Spinal Deformity Correction! Review types of procedure details, benefits, & eligibility requirements from a master in his field! Jul 24, 2016 · Smith-Petersen osteotomy (SPO) is a chevron resection of the posterior elements that shorten the posterior column and lengthen the anterior column upon closure (FIG 1A). Three-column pedicle subtraction osteotomy is an efficient technique to restore lumbar lordosis (LL) for fixed sagittal malalignment. OBSERVATIONS The authors The Current Procedural Terminology (CPT ®) code 22214 as maintained by American Medical Association, is a medical procedural code under the range - Osteotomy Procedures on the Spine (Vertebral Column). ( the criteria for billing 22633 and 22634 says it has to be a combined posterior with posterior interbody approach. 5: Posterior Cervical Fusion (Initial or Repeat) for Symptomatic Sep 1, 2013 · Spine procedure coding can make even the most confident coder squirm. Feb 6, 2020 · Pedicle Subtraction Osteotomy - Dr. Typically the L5 pedicle is extremely anterior, hidden beneath the sacral alar. com Jul 7, 2025 · BACKGROUND Iatrogenic flat back syndrome following prior posterolateral fusion without interbody support is challenging, especially with adjacent segment stenosis. BlueCross BlueShield of MN Spine Surgery Comprehensive Code List CPT® copyright 2022 American Medical Association. Jun 12, 2023 · Spinal osteotomy is an umbrella term for techniques used by spinal surgeons to correct spinal deformity. While pedicle subtraction osteotomy (PSO) offers strong correction, it is associated with higher morbidity. The procedure involves careful Jul 24, 2025 · This page addresses follow-up questions and additional information pertinent to our webinar Next Level Spine Coding Part 1: Walking Through Case Studies for Posterior Spinal Fusions. Arthrodesis is typically associated with an osteotomy; “it’s essential to have a fusion at that interspace level,” according to Kapurch. These can be broken down into posterior column osteotomy (PCO), including Ponte osteotomy and Smith-Petersen osteotomy (SPO), pedicle Spinal Deformity Correction Procedures When reporting spinal deformity correction procedures, it is important to recognize that an osteotomy involves cutting and/or removing bone to alter the spine or to correct a curvature with the indication of restoring or improving spinal alignment. Spine osteotomy is a surgical procedure that involves cutting and removing a section of spinal bone to correct spinal malalignment. Surgery is often necessary for a comprehensive correction of the underlying cause of these deformities, such as scoliosis, kyphosis, or flat back syndrome. If there is no spinal deformity documented, we recommend querying the surgeon for the intent of the osteotomy. 0): 559 Aftercare, musculoskeletal system and connective tissue with mcc 560 Aftercare, musculoskeletal system and connective tissue Keywords: Kyphosis, Osteotomy, Spinal fusion, Cervical spine, Cervical deformity, Corpectomy INTRODUCTION The cervical spine functions to bear the axial load of the head, optimize forward gaze in an erect posture, maintain physiologic head and neck movement, and to support and protect vital neurovascular structures. All rights reserved. Closure of the osteotomy site involved compression and extension of the bed position. The aims of spinal deformity surgery are to achieve balance, relieve pain and prevent recurrence or worsening of the deformity. More specifically, an osteotomy is a restructuring procedure that involves extracting entire vertebrae or sections of vertebrae. The indications for using a 3CO in the surgical treatment of Adult Spinal Deformity (ASD) have slowly evolved over time but remains idiosyncratic for surgeons treating complex ASD patients. These include the posterior column osteotomy (PCO), the pedicle subtraction osteotomy (PSO), and vertebral column resection (VCR). SPO is a posterior column osteotomy in which the posterior Aug 22, 2022 · Abstract Background: Three-column osteotomies (3COs), usually in the form of pedicle subtraction or vertebral column resection, have become common in adult spinal deformity surgery. This manuscript will focus on the past and Disclaimer The following presentations are not to be considered a replacement for the Current Procedural Terminology (CPT) book or the International Classification of Diseases 10th Revision-Clinical Modification (ICD-10-CM) book. A vertebral interspace is the non-body compartment between two adjacent vertebral bodies, which contains the intervertebral disk, and includes the nucleus pulposus, annulus fibrosus, and two cartilagenous endplates. It is a more radical procedure that involves removal of all the posterior elements and a wedge section of the vertebral body. 22633 and 22634 x 3 for the fusion done at T10-T11, T11-T12, T12-L1, L1-L2. Although a powerful tool for deformity correction, 3COs can increase the risks of perioperative morbidity. However, a long Feb 16, 2025 · For these cases, osteotomy is often done along with spinal fusion to help stabilize the spine and improve balance. While outcomes have been reported in the literature with 2 years follow-up, longer-term outcomes of three-column osteotomies remain understudied. First utilized in spine surgery in the late 1980s, the Ponte osteotomy is a method of surgically shortening the posterior column in order to obtain greater corrective power in the management of kyphosis or kyphoscoliosis. The conversion of a growing rod construct to a final posterior spine fusion with instrumentation involves removal of segmental instrumentation, more fusion, insertion of different instrumentation, bone grafts, and possibly Ponte or Smith-Petersen osteotomies. Surgeons should be prepared to manage associated complications such as dural tear and massive blood loss. Normally, the spine has two Osteotomy is a surgical procedure to realign bones and relieve joint pain. The purpose is to establish normal range spinal curvature, relieve pain, and improve quality of life. Fusion of vertebrae T12 and L1 using bone Outlook Spine osteotomy is recommended for patients whose deformity is progressing and non-surgical methods are ineffective. Mar 27, 2012 · Osteotomies are done for correction of a spinal deformity such as arthritis, severe kyphosis, etc, so make sure he really did an osteotomy but I would bill as follows. Mar 2, 2009 · After a wedge osteotomy of L1-2 with spinal fusion, the patient was returned to bed with the original, deformed position maintained by pillows and cushions, which were removed gradually during the course of the next two or three days, and the kyphotic deformity was corrected. 2: Osteotomy CMM-604. A spinal fusion with instrumentation may also be performed along with spine osteotomy to stabilize the spine and prevent further curvature. Your jaw, elbow, spine, shoulder, hips, knees, legs, toes and feet are common surgical sites. Lumbar osteotomy performed without meeting the criteria in the General Guidelines (when applicable for urgent/emergent conditions) and the criteria in the applicable procedure-specific section (osteotomy; pediatric spinal deformity; fusion with decompression; fusion without decompression; adjacent segment disease; fusion following failed disc Summary of background data: The Ponte osteotomy, originally developed for thoracic kyphosis, was the first one to obtain posterior shortening of the thoracic spine, maintaining the anterior column load-sharing capacity. OBSERVATIONS The authors present the case of a 71-year-old woman with a Dec 1, 2022 · When planning and executing spinal osteotomies, the ultimate goals are to restore spinal balance, relieve pain, prevent recurrence, and obtain a solid fusion. These procedures will be discussed in detail in our PCS Spinal Fusions Advanced webinar on April 15, 2021. Intraoperative fluoroscopy or spinal navigation is used to facilitate identification of correct levels. q0kpihxltpirmwcxpl4ebcar7jt9skdgclpmgwbq9qosran