64493 Injection(s), diagnostic or therapeutic agent, paravertebral facet (zygapophyseal) joint (or nerves innervating that joint) with image guidance (fluoroscopy or CT), lumbar or sacral; single level

Name of the Procedure:

Paravertebral Facet Joint Injection (or Zygapophyseal Joint Injection), Diagnostic or Therapeutic Agent, with Image Guidance (Fluoroscopy or CT), Lumbar or Sacral; Single Level

Summary

This procedure involves injecting a diagnostic or therapeutic agent into the lumbar or sacral facet joints or the nerves that supply these joints. It utilizes imaging guidance such as fluoroscopy or CT to ensure accurate placement.

Purpose

This procedure aims to alleviate pain originating from the lumbar or sacral facet joints. It can help diagnose the source of back pain or provide therapeutic relief by reducing inflammation in the joints.

Indications

• Chronic lower back pain suspected to be due to facet joint pathology
• Acute exacerbations of chronic back pain
• Pain not responding to conservative treatments like medication or physical therapy
• Need for diagnostic clarity on the source of back pain

Preparation

• Patients may need to fast for a few hours before the procedure.
• Adjustments to medications, especially blood thinners, might be required.
• Pre-procedure imaging or diagnostic tests might be needed to pinpoint the target area.

Procedure Description

1. The patient is positioned on an imaging table.
2. Local anesthesia is administered to numb the injection site.
3. Using fluoroscopy or CT imaging, the healthcare provider guides a needle to the facet joint or the nerves.
4. A diagnostic dye may be injected first to confirm accurate placement.
5. The therapeutic agent (e.g., corticosteroid) is then injected into the joint or around the nerves.
6. The needle is removed, and the injection site is dressed.

Duration

The procedure typically takes 20-30 minutes.

Setting

Usually performed in an outpatient clinic, radiology suite, or surgical center.

Personnel

• Radiologist or Pain Management Specialist
• Nurse or Medical Assistant
• Anesthesiologist (if sedation is used)

Risks and Complications

• Common: Temporary pain at the injection site, dizziness, headache
• Rare: Infection, bleeding, nerve damage, allergic reaction to the injection substances

Benefits

• Pain relief, potentially immediate or within a few days
• Improved function and mobility
• Diagnostic clarity that can guide further treatment

Recovery

• Patients are usually observed for a short period post-procedure.
• Rest is recommended for the remainder of the day.
• Avoid strenuous activities for a few days.
• Follow-up appointments may be needed to assess the effectiveness.

Alternatives

• Physical therapy
• Oral medications, such as NSAIDs or muscle relaxants
• Radiofrequency ablation
• Surgical interventions
• Each alternative has varying degrees of invasiveness, effectiveness, and recovery time.

Patient Experience

• During the procedure: Minimal discomfort due to local anesthesia; brief period of pressure or pain as the needle is placed.
• After the procedure: Mild soreness at the injection site, usually manageable with over-the-counter pain relievers.
• Pain relief might be immediate or gradual over several days to a week.