64494 Injection(s), diagnostic or therapeutic agent, paravertebral facet (zygapophyseal) joint (or nerves innervating that joint) with image guidance (fluoroscopy or CT), lumbar or sacral; second level (List separately in addition to code for primary procedure)

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), lumbar or sacral; second level. Commonly known as lumbar or sacral facet joint injection with image guidance.

Summary

Facet joint injections are used to diagnose or treat pain originating from the joints in your lower back (lumbar) or pelvis (sacral) by injecting medication directly into the affected area under image guidance.

Purpose

This procedure helps address chronic back pain or inflammation coming from the facet joints. The goal is to reduce pain, improve mobility, and help diagnose the source of pain.

Indications

Facet joint injections are typically recommended for:

• Chronic lower back pain.
• Pain that does not respond to conservative treatments such as medication or physical therapy.
• Pain believed to originate from the facet joints.

Preparation

• Patients may be instructed to fast for several hours before the procedure.
• Adjustments to medications, especially blood thinners, may be necessary.
• Pre-procedure diagnostic imaging such as MRI or CT scans may be required.

Procedure Description

1. The patient lies face down on a procedure table.
2. The skin over the injection site is cleaned and numbed with a local anesthetic.
3. Using fluoroscopy (X-ray) or CT imaging, the physician guides a needle into the facet joint or the nerves around it.
4. A diagnostic or therapeutic agent (anesthetic and/or steroid) is injected into the joint.
5. The needle is removed, and the injection site is covered with a small bandage.

Tools: Needle, contrast dye, fluoroscopy or CT machine, anesthetic, and steroid medication. Anesthesia: Local anesthesia is used; sedation is not typically necessary.

Duration

The procedure typically takes around 20-30 minutes.

Setting

This procedure is usually performed in an outpatient clinic or radiology center.

Personnel

• Physician (typically a pain management specialist or radiologist)
• Radiologic technologist
• Nurse or medical assistant

Risks and Complications

Common risks include:

• Temporary increase in pain
• Infection at the injection site
• Bleeding or bruising Rare complications:
• Nerve damage
• Allergic reaction to the medication

Benefits

• Potential immediate pain relief from the anesthetic.
• Long-term pain relief from the steroid.
• Improved mobility and quality of life.
• Diagnostic value in identifying pain sources.

Recovery

• Patients are typically observed for a short period and then discharged the same day.
• Mild soreness at the injection site may occur.
• Patients should avoid strenuous activities for 24 hours.
• Follow-up appointments may be scheduled to assess effectiveness.

Alternatives

• Oral or topical pain medications.
• Physical therapy and exercise programs.
• Radiofrequency ablation.
• Surgery (for severe cases).

Pros and cons: Alternatives may have less immediate effects but fewer risks, while surgery is more invasive but could provide a permanent solution.

Patient Experience

During the procedure, patients might feel pressure or mild discomfort when the needle is inserted. Post-procedure, they may experience soreness or an initial increase in pain, which usually subsides within a few days. Pain management and comfort measures will be provided, including ice packs and over-the-counter pain relievers.