FOR THE OPEN SI FUSION, 27280?
WHAT ABOUT THE REMOVAL OF PREVIOUS HARDWARE?
SHOULD WE USE 22830 FOR EXPLORATION?
I HAVE ONE PERSON SAYING TO USE, "27280, 22830, AND 22853."
AND ANOTHER SAYING, "27280, AND 22899"
PLEASE HELP. PLEASE EXPLAIN YOUR ANSWER SO THAT I AM ABLE TO UNDERSTAND.
THANK YOU!!
PREOPERATIVE DIAGNOSES:
1. Right sacroiliac joint nonunion.
2. Ongoing chronic debilitating right sacroiliac joint pain with
significant dysfunction.
*
POSTOPERATIVE DIAGNOSES:
1. Right sacroiliac joint nonunion.
2. Ongoing chronic debilitating right sacroiliac joint pain with
significant dysfunction.
*
PROCEDURE: Complex removal of previously placed right sacroiliac joint
implants that did result in a nonunion. The 3 implants were ultimately
removed, and I did proceed with an open revision fusion procedure of the
right sacroiliac joint, with placement of revision implants across the
sacroiliac joint (using allograft bone, ViviGen).
*
SURGEON:
*
ASSISTANT:
*
ANESTHESIA: General endotracheal anesthesia.
*
COMPLICATIONS: None.
*
DISPOSITION: Stable.
*
ESTIMATED BLOOD LOSS: 50 mL.
*
INDICATIONS FOR SURGERY: Briefly, patient is a pleasant 49-year-old
female, who did initially present to me on September 13, 2016, with
substantial pain at the right side of her low back. Of note, she was
previously diagnosed with right sacroiliac joint dysfunction and did
have a right sacroiliac joint fusion procedure by another surgeon on May
1, 2015. Per the patient, she feels that she has been having ongoing
and rather severe dysfunction and pain in her right sacroiliac joint
ever since that procedure. She states the simple activities of daily
living such as even using the restroom are extremely difficult for her
on a daily basis. A CAT scan did reveal a nonunion with malpositioned
implants. She did wish to have the implants removed, and I did discuss
with her proceeding with a revision fusion procedure. She did wish to
proceed.
*
OPERATIVE DETAILS: On August 9, 2018, the patient was brought to
surgery and general endotracheal anesthesia was administered. The
patient was placed prone on the operating room table with gel rolls
placed under the patient’s chest and hips. The right buttock was
prepped and draped in the usual sterile fashion and a time-out procedure
was performed. I did expose down to the lateral ilium. Of note,
visualization of the implants were extremely difficult, given the
extensive scar tissue and the patient’s body habitus. I was, however,
able to optimally visualize the lateral aspect of the implants. Using
the iFuse sacroiliac joint removal system, I did thread guide over the
lateral aspect of the implants. The lower implant was removed
uneventfully. The middle implant did require a moderate degree of force
to ultimately remove; however, I was able to remove it uneventfully.
The upper implant I was not able to remove using a slap hammer. I did
have to use a chisel, which was slid over the lateral aspects of each
side of the triangular implant down to just into the sacrum. After
doing so, I then threaded the implant removal, slap hammer into the
lateral aspect of the implant, and at this point, I was able to
successfully remove the implant. In the lower hole where the lowest
implant was removed, I did place a significant amount of Gelfoam. At
the upper implant, I did drill. I did place a guidewire into the hole
that remained. I did drill over the hole and I did place a revision
implant, specifically, a 10 x 60 mm SI-LOK implant (globus). Allograft
in the form of ViviGen was packed into the implant. I was very pleased
with the resting position of the implant. Where the middle implant was
removed, I then drilled over a guidewire, and at this particular implant
level, I did elect to place a 12 x 45 mm implant, again, packed with
ViviGen. I did liberally use lateral as well as outlet fluoroscopy in
order to ensure that the implants were in their appropriate resting
positions. I was very pleased with the final press-fit of each of the
final screws. At this point, the wound was copiously irrigated. There
were minor areas of bleeding, which was controlled using bipolar
electrocautery. The wound was then closed in layers using #1 Vicryl,
followed by 0 Vicryl, followed by 2-0 Vicryl, followed by 4-0 Monocryl.
Benzoin and Steri-Strips were applied, followed by sterile dressing.
All instrument counts were correct at the termination of the procedure.
*
Of note, PA-C, was my assistant throughout surgery, and
did aid in retraction, suctioning, and closure from start to finish.