64491 Injection(s), diagnostic or therapeutic agent, paravertebral facet (zygapophyseal) joint (or nerves innervating that joint) with image guidance (fluoroscopy or CT), cervical or thoracic; second level (List separately in addition to code for primary proced

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; second level

Summary

The procedure involves injecting a diagnostic or therapeutic agent into the facet joint or the nerves innervating that joint in the cervical or thoracic spine using image guidance such as fluoroscopy or CT. This is typically an additional level beyond the primary procedure.

Purpose

This procedure is utilized to both diagnose and treat pain originating from the facet joints in the cervical or thoracic spine. It aims to relieve pain by reducing inflammation or by numbing specific nerves causing discomfort.

Indications

• Chronic pain in the neck or upper back
• Pain that radiates from the neck or upper spine
• Diagnosis of facet joint-related pain
• Lack of response to conservative treatments such as physical therapy or medications

Preparation

• Patients may be advised to fast for several hours before the procedure.
• Adjustments to medications, especially blood thinners, might be necessary.
• Diagnostic imaging such as MRI or CT scans may be required beforehand.
• Pre-procedure consultation to discuss medical history and allergies.

Procedure Description

1. Positioning: The patient is positioned face down on an examination table.
2. Anesthesia: Local anesthesia is administered to numb the injection site.
3. Image Guidance: Fluoroscopy or CT is used to locate the specific facet joint.
4. Injection: A needle is guided into the targeted facet joint or nerve under continuous imaging. A contrast dye may be injected to confirm correct placement.
5. Agent Administration: The therapeutic or diagnostic agent is injected into the joint or around the nerve.

Duration

The procedure typically takes between 30 to 60 minutes.

Setting

This procedure is usually performed in an outpatient clinic, hospital, or a surgical center.

Personnel

• Pain management specialist or interventional radiologist
• Radiologic technologist for image guidance
• Nurse to assist with patient care

Risks and Complications

• Common: Temporary pain at the injection site, localized bleeding, or bruising
• Rare: Infection, allergic reaction to the injected substances, nerve damage, or worsening pain

Benefits

• Pain relief often begins within a few days
• Improved mobility and quality of life
• Identification of the pain source for more targeted treatments

Recovery

• Patients often return home the same day.
• Post-procedure instructions may include avoiding strenuous activities for 24 hours.
• A follow-up appointment will assess the effectiveness and plan further treatment if necessary.

Alternatives

• Physical therapy
• Oral anti-inflammatory medications or pain relievers
• Other types of nerve blocks or spinal injections
• Surgical interventions in severe cases

Patient Experience

During the procedure, the patient may feel pressure or mild discomfort as the needle is inserted. Post-procedure, soreness at the injection site is common but manageable with over-the-counter pain medications. Most patients can resume normal activities within a day, following doctor's recommendations.