Collapsed vertebra, not elsewhere classified, occipito-atlanto-axial region
ICD-10 M48.51 is a billable code used to indicate a diagnosis of collapsed vertebra, not elsewhere classified, occipito-atlanto-axial region.
Collapsed vertebrae in the occipito-atlanto-axial region refer to a condition where one or more vertebrae in the upper cervical spine (the area encompassing the occiput, atlas, and axis) have lost structural integrity, leading to a decrease in height or collapse. This condition can arise from various etiologies, including trauma, malignancy, osteoporosis, or inflammatory diseases such as ankylosing spondylitis. The occipito-atlanto-axial region is critical for craniovertebral junction stability and mobility, and collapse in this area can lead to significant neurological deficits due to compression of the spinal cord or nerve roots. Patients may present with neck pain, restricted range of motion, and neurological symptoms such as weakness or sensory changes. Diagnosis typically involves imaging studies such as X-rays, CT scans, or MRIs to assess vertebral alignment and integrity. Treatment may vary from conservative management, including physical therapy and pain management, to surgical interventions aimed at stabilizing the spine and decompressing neural structures.
Detailed imaging reports, surgical notes, and pre-operative assessments.
Surgical intervention for vertebral stabilization or decompression.
Documentation must clearly outline the surgical approach and rationale for intervention.
Neurological assessments, imaging results, and treatment plans.
Management of neurological symptoms resulting from vertebral collapse.
Clear documentation of neurological deficits and their correlation with imaging findings.
Used in cases of vertebral collapse requiring stabilization.
Operative report detailing the procedure and indication for surgery.
Orthopedic surgeons must document the rationale for surgical intervention.
The primary causes can include trauma, malignancy, osteoporosis, or inflammatory conditions such as ankylosing spondylitis. Each case should be evaluated individually to determine the underlying cause.
