Lorio Morgan P, Nunley Pierce D, Heller Joshua E, McCormack Bruce M, Lewandrowski Kai-Uwe, Block Jon E
Advanced Orthopedics, 499 East Central Parkway, Altamonte Springs, FL 32701, USA.
Spine Institute of Louisiana, 1500 Line Ave, Ste. 200, Shreveport, LA 71101, USA.
J Pers Med. 2024 Aug 7;14(8):837. doi: 10.3390/jpm14080837.
The traditional open midline posterior cervical spine fusion procedure has several shortcomings. It can cause soft tissue damage, muscle atrophy, compromise of the lateral masses and painful prominent posterior cervical instrumentation or spinous process if there is dehiscence of the fascia. Additionally, patients frequently experience the rapid development of adjacent segment disease, which can result in the reemergence of debilitating pain and functional impairment. Tissue-sparing posterior cervical fusion is an alternative method for treating patients with symptomatic cervical degenerative disc disease. However, widespread clinical adoption has been challenged by ambiguity, misunderstandings and misinterpretations regarding appropriate procedural reimbursement coding. : The tissue-sparing posterior cervical fusion procedure was approved by the US Food and Drug Administration (FDA) in 2018 (CORUS™ Spinal System and CAVUX Facet Fixation System (CORUS/CAVUX); Providence™ Medical Technology). This technique addresses the concerns with traditional spine fusion methods by achieving the stability and outcomes of posterior cervical fusion without the morbidity associated with significant muscle stripping in the traditional approach. This technology uses specialized implants and instrumentation to perform all of the steps required to facilitate bone fusion and provide stability while minimizing tissue disruption. The technique involves extensive bone preparation for fusion and placement of specialized stabilization implants that span the facet joint, promoting natural bone growth and fusion while reducing the need for extensive exposure. This procedure provides an effective, less invasive solution for patients with cervical degenerative disc disease. The article provides a comprehensive rationale for appropriate reimbursement coding for tissue-sparing posterior cervical fusion. This is a critical aspect for the adoption and accessibility of medical technologies. This information is crucial for practitioners and healthcare administrators, ensuring that innovative procedures are accurately coded and reimbursed. By detailing the procedural steps, instruments used and the physiological basis for the procedure, this article serves as a valuable educational resource for spine surgeons and payers to appropriately code for this procedure. The description of work for CORUS/CAVUX is equivalent to the current surgical standard of lateral mass screw fixation with decortication and onlay posterior grafting to facilitate posterior fusion. Thus, it is recommended that CPT codes 22600/22840 be used, as they best reflect the surgical approach, instrumentation, decortication, posterior cervical fusion and bone grafting procedures.
传统的开放型颈椎后路中线融合手术存在几个缺点。它可能会导致软组织损伤、肌肉萎缩，如果筋膜裂开，还会影响侧块以及造成颈椎后路器械或棘突突出疼痛。此外，患者经常会迅速出现相邻节段疾病，这可能导致使人衰弱的疼痛和功能障碍再次出现。保留组织的颈椎后路融合术是治疗有症状的颈椎间盘退变疾病患者的一种替代方法。然而，由于对适当的手术报销编码存在模糊性、误解和错误解读，该方法在临床上的广泛应用受到了挑战。保留组织的颈椎后路融合手术于2018年获得美国食品药品监督管理局（FDA）批准（CORUS™脊柱系统和CAVUX小关节固定系统（CORUS/CAVUX）；普罗维登斯™医疗技术公司）。该技术通过实现颈椎后路融合的稳定性和效果，同时避免传统方法中因大量肌肉剥离而产生的并发症，解决了传统脊柱融合方法存在的问题。这项技术使用专门的植入物和器械来完成促进骨融合和提供稳定性所需的所有步骤，同时将组织破坏降至最低。该技术包括为融合进行广泛的骨准备以及放置跨越小关节的专门稳定植入物，促进自然骨生长和融合，同时减少广泛暴露的需求。该手术为颈椎间盘退变疾病患者提供了一种有效、侵入性较小的解决方案。本文为保留组织的颈椎后路融合术的适当报销编码提供了全面的理论依据。这是医疗技术采用和可及性的一个关键方面。这些信息对从业者和医疗管理人员至关重要，可确保创新手术得到准确编码和报销。通过详细说明手术步骤、所用器械以及手术的生理基础，本文为脊柱外科医生和支付方提供了有价值的教育资源，以便为该手术进行适当编码。CORUS/CAVUX的工作描述等同于目前外侧块螺钉固定并去皮质及植骨促进后路融合的手术标准。因此，建议使用CPT编码22600/22840，因为它们最能反映手术入路、器械使用、去皮质、颈椎后路融合和植骨手术。
