Clinical Context
A 54-year-old adult with a history of progressive thoracolumbar kyphotic deformity secondary to congenital spina bifida and prior spinal fusion presents with chronic severe back pain, progressive sagittal imbalance, and neurologic claudication unrelieved by conservative care (physical therapy, analgesics, and epidural injections). Imaging (standing radiographs, CT, and MRI) demonstrates rigid kyphosis with apex across three contiguous vertebral levels, focal spinal cord compression, and failure of previous posterior instrumentation. The spine surgery team schedules an operative kyphectomy with excision of three or more complete vertebral segments to correct deformity, decompress neural elements, and restore sagittal alignment.
Preoperative workflow includes multidisciplinary evaluation (neurosurgery/orthopedic spine, anesthesia, and physical therapy), informed consent documenting high-risk features, optimization of medical comorbidities, and preoperative imaging review. Intraoperative steps include general endotracheal anesthesia, intraoperative neuromonitoring, posterior and/or combined anterior-posterior exposure as indicated, resection of three or more vertebral bodies (kyphectomy), neural decompression, reconstruction with instrumentation and fusion, and wound closure. Postoperative care includes ICU monitoring for the first 24–72 hours for hemodynamic and neurologic stability, pain control, early mobilization with bracing as indicated, and tailored rehabilitation. Discharge planning involves outpatient follow-up for incision check, radiographic assessment of construct alignment, and long-term fusion surveillance.
Related CPT Codes
| CPT Code | Description | Relationship to This Procedure |
|---|
22819 | Kyphectomy, excision of three or more complete vertebral segments | Primary procedure for resection of three or more vertebral bodies to correct kyphotic deformity and decompress neural elements. |
| 22633 | Arthrodesis, combined posterior or posterolateral technique with posterior interbody technique including laminectomy and/or discectomy to prepare interspace (eg, TLIF), single level; lumbar | May be performed during the same operative session for reconstruction and fusion adjacent to the kyphectomy site.
| 22842 | Posterior segmental instrumentation (eg, pedicle fixation, each additional segment) | Commonly reported for instrumentation and stabilization of the spine after vertebral resection and fusion.
| 22845 | Anterior instrumentation | Used when anterior column support or anterior instrumentation is placed as part of combined approach reconstruction.
| 20930 | Allograft, morselized or structural, for spine surgery | Reported when structural graft or allograft is used to reconstruct the anterior column after vertebral body resection.
| 61635 | Laminectomy for excision of intradural tumor; thoracic | Example of an additional decompressive procedure that may be performed if intradural pathology is encountered during kyphectomy; relates to neural decompression when indicated.