64490 Injection(s), diagnostic or therapeutic agent, paravertebral facet (zygapophyseal) joint (or nerves innervating that joint) with image guidance (fluoroscopy or CT), cervical or thoracic; single level

Name of the Procedure:

Injection(s), diagnostic or therapeutic agent, paravertebral facet (zygapophyseal) joint (or nerves innervating that joint) with image guidance (fluoroscopy or CT), cervical or thoracic; single level

Summary

This procedure involves injecting a diagnostic or therapeutic agent into or around the facet joints in the cervical (neck) or thoracic (upper back) spine with the aid of imaging techniques like fluoroscopy or CT scans to ensure precise placement. It can be used to diagnose the source of pain or to provide therapeutic relief.

Purpose

This procedure is designed to manage pain originating from the cervical or thoracic spine facet joints. It aims to reduce inflammation and pain in the spine, help diagnose the source of pain, and improve the patient's range of motion and quality of life.

Indications

• Chronic neck or upper back pain
• Pain not relieved by conservative treatments such as medication or physical therapy
• Pain attributed to arthritis or injury in the facet joints
• Diagnostic clarification to determine the source of spinal pain

Preparation

• Fasting may be required for several hours prior to the procedure.
• Patients may need to adjust certain medications; for example, blood thinners might need to be temporarily discontinued.
• Pre-procedure imaging and assessments may be conducted to plan the injection site.

Procedure Description

1. The patient is positioned on the procedure table, and the skin over the injection site is sterilized.
2. Local anesthesia is administered to numb the area.
3. Using fluoroscopy or CT guidance, the physician inserts a needle into or near the facet joint(s).
4. A diagnostic or therapeutic agent is injected.
5. Imaging is used throughout to ensure accurate placement of the needle and medication.

Duration

The procedure typically takes about 30 minutes to 1 hour.

Setting

This procedure is usually performed in an outpatient clinic, hospital radiology department, or surgical center with imaging capabilities.

Personnel

• Interventional radiologist or spine specialist
• Nurses
• Radiology technician, if necessary
• Anesthesiologist, if sedation is used

Risks and Complications

• Infection at the injection site
• Bleeding
• Allergic reaction to the injected substance
• Temporary increase in pain
• Nerve damage (rare)

Benefits

• Pain relief, which may be rapid but varies between patients
• Improved ability to perform daily activities
• Diagnostic clarity if used to identify pain sources

Recovery

• Patients may be observed for a short period post-procedure to monitor for adverse reactions.
• Mild soreness at the injection site is common; patients may use ice packs or take over-the-counter pain relief.
• Normal activities can often be resumed within a day, but heavy lifting and strenuous activities should be avoided for 24-48 hours.
• Follow-up appointments may be scheduled to assess response to the injection.

Alternatives

• Conservative treatments like physical therapy, medications, or chiropractic care
• Other interventional procedures like radiofrequency ablation
• Surgical options, if appropriate

Patient Experience

During the procedure, patients may feel pressure or mild discomfort at the injection site. Post-procedure, mild soreness or temporary exacerbation of pain is possible. Effective pain management includes the use of local anesthetics and, if needed, sedation to ensure comfort throughout the process.