The National Institute for Health and Clinical Excellence (NICE) has issued full guidance to the NHS in England, Wales, Scotland and Northern Ireland on direct C1 lateral mass screw for cervical spine stabilisation.
Atlantoaxial instability (excessive movement between the first and second vertebrae of the neck) can be caused by trauma, malignancy, inflammatory or congenital defects. It can present as local spinal pain, but if the spinal cord is compressed symptoms such as clumsiness, lack of coordination, difficulty walking, high cervical paralysis or death may occur. Treatment is by stabilisation of the C1 on to the C2 vertebrae.
Traditional methods of atlantoaxial fusion involve the use of wires and bone grafts. They require external support in the post-operative period, including the use of halo devices. Rigid fixation by transarticular screws between C1 and C2 have been described which do not require external fixation but this procedure is not appropriate for every case. A new procedure has been developed which achieves rigid fixation between C1 and C2 by the use of a screw placed in each bone and connection of these screws with rods and a plate.
Under general anaesthesia, the patient is placed prone and standard posterior exposure of the cervical spine is performed. Screws are inserted into the lateral masses of C1 and fixed by a rod to screws in the lateral masses or pedicles of C2. The posterior arch of bone compressing the spinal cord may be removed. An onlay graft of bone permits a permanent fusion between C1 and C2.
V37.1 Posterior fusion of atlantoaxial joint NEC
V55.1 One level of spine
V37.6 Posterior fusion of atlantoaxial joint using pedicle screw
V55.1 One level of spine
Note: Codes within category V55.- are assigned in second place each time a spinal operation is coded: if the levels of spine are not specified, V55.9 Unspecified levels of spine is used.
The NHS Classifications Service has advised NICE that currently these are the most suitable OPCS-4 codes to describe this procedure. The OPCS-4 classification is designed to categorise procedures for analysis and it is not always possible to identify a procedure uniquely.
The NHS Classifications Service of NHS Connecting for Health is the central definitive source for clinical coding guidance and determines the coding standards associated with the classifications (OPCS-4 and ICD-10) to be used across the NHS. The NHS Classifications Service and NICE work collaboratively to ensure the most appropriate classification codes are provided. www.connectingforhealth.co.uk/clinicalcoding