Percutaneous aspiration within the nucleus pulposus, intervertebral disc, or paravertebral tissue for diagnostic purposes
CPT4 code
Name of the Procedure:
Percutaneous Aspiration within the Nucleus Pulposus, Intervertebral Disc, or Paravertebral Tissue for Diagnostic Purposes
- Also known as: Intervertebral Disc Aspiration, Paravertebral Tissue Aspiration
Summary
Percutaneous aspiration is a minimally invasive procedure where a needle is inserted through the skin to collect fluid or tissue samples from the intervertebral disc, nucleus pulposus, or nearby paravertebral tissues. This is primarily done for diagnostic purposes to identify infections, inflammations, or other pathological conditions.
Purpose
This procedure aims to diagnose conditions affecting the spine, such as infections (e.g., discitis), inflammations, or neoplastic processes. By analyzing the aspirated sample, healthcare providers can determine the underlying cause of a patient's symptoms and tailor appropriate treatment plans.
Indications
- Unexplained back pain or sciatica
- Suspected discitis (infection of the intervertebral disc)
- Suspected malignancy within the intervertebral disc or adjacent tissues
- Unclear spinal abnormalities seen on imaging studies
Preparation
- Patients may need to fast for a few hours before the procedure.
- Anticoagulant medications might be paused to reduce bleeding risks.
- Diagnostic imaging (such as MRI or CT scans) is often performed beforehand to localize the area for aspiration.
Procedure Description
- The patient is positioned to provide optimal access to the target area.
- The skin over the site is cleansed and sterilized.
- Local anesthesia is administered to numb the area.
- Using imaging guidance (fluoroscopy, CT), the physician inserts a fine needle through the skin and advances it to the intervertebral disc or paravertebral tissue.
- Fluid or tissue is aspirated into a syringe.
The needle is withdrawn, and a sterile dressing is applied to the puncture site.
Duration
The procedure typically takes about 30 to 60 minutes.
Setting
This procedure is most often performed in a hospital radiology department, outpatient clinic, or surgical center.
Personnel
- Radiologist or spine specialist (often an interventional radiologist)
- Nurses
- Radiologic technologist
Risks and Complications
- Infection at the puncture site
- Bleeding or hematoma formation
- Nerve injury
- Disc herniation or worsening of existing spinal conditions (rare) #### Benefits
- Precise diagnosis of spinal conditions
- Targeted treatment decisions
- Minimally invasive with quicker recovery compared to open surgical biopsies
Recovery
- Patients are usually monitored for a short time after the procedure.
- Instructions include keeping the puncture site clean and dry.
- Mild discomfort or soreness is expected and can be managed with over-the-counter pain medications.
- Most patients can resume normal activities within a day or two, but heavy lifting or strenuous activity should be avoided for about a week.
Alternatives
- Open surgical biopsy
- Observation and conservative management with medications and physical therapy
- Advanced imaging techniques (MRI, CT) without aspiration
Pros and Cons
Pros:
- Less invasive than open surgery
- Quick recovery time Cons:
- May not always yield sufficient or conclusive diagnostic information
- Potential for infection or complications
Patient Experience
- During the procedure, the patient will feel a local anesthetic injection, similar to a sting or pinch.
- Pressure or slight discomfort as the needle is positioned may occur but severe pain is uncommon.
- Post-procedure soreness at the site is expected but typically mild and manageable.
- Detailed aftercare instructions will be provided to ensure smooth recovery.