64635 Destruction by neurolytic agent, paravertebral facet joint nerve(s), with imaging guidance (fluoroscopy or CT); lumbar or sacral, single facet joint

Name of the Procedure:

Destruction by Neurolytic Agent, Paravertebral Facet Joint Nerve(s), with Imaging Guidance (Fluoroscopy or CT); Lumbar or Sacral, Single Facet Joint.

Summary

This procedure involves the use of a neurolytic agent to destroy nerves in the lumbar or sacral facet joints responsible for chronic pain. It is performed using imaging techniques like fluoroscopy or CT to guide the precise placement of the neurolytic substance.

Purpose

This procedure aims to alleviate chronic pain in the lower back or sacral area by targeting the facet joint nerves. By disrupting pain signals, it can improve a patient’s mobility and quality of life.

Indications

• Chronic lower back pain not responsive to conservative treatments.
• Pain originating from lumbar or sacral facet joints.
• Confirmation of facet joint pain via diagnostic block injections.
• Patients with specific lower back conditions such as facet joint arthritis.

Preparation

• Patients may be asked to avoid eating or drinking for a few hours before the procedure.
• Certain medications, particularly blood thinners, may need to be adjusted or stopped temporarily.
• Diagnostic imaging or tests may be conducted to confirm the pain source.

Procedure Description

1. The patient is positioned to allow easy access to the lumbar or sacral region.
2. The area is sterilized and local anesthesia is administered to numb the injection site.
3. Using fluoroscopy or CT imaging, a needle is precisely guided to the targeted nerve area.
4. Once the needle is in place, a neurolytic agent (such as alcohol, phenol, or radiofrequency energy) is injected to destroy the nerve tissue.
5. The needle is removed, and the injection site is covered with a sterile bandage.

Duration

The procedure typically takes 30 to 60 minutes, including preparation and recovery time.

Setting

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

Personnel

• Interventional radiologist or pain management specialist.
• Nurses.
• Imaging technicians.
• Anesthesiologist (if deeper sedation is required).

Risks and Complications

• Localized pain or swelling at the injection site.
• Temporary numbness or weakness in the treated area.
• Infection.
• Bleeding.
• Allergic reaction to the neurolytic agent.
• Rarely, accidental injury to nearby structures.

Benefits

• Significant reduction in chronic pain levels.
• Improved mobility and function.
• Decreased reliance on pain medications.
• Symptom relief can be seen within days to weeks post-procedure.

Recovery

• Patients may rest for a short period under observation before going home.
• Avoid strenuous activities for 24-48 hours post-procedure.
• Follow-up appointments to assess pain relief and monitor for complications.
• Pain management strategies, if necessary.

Alternatives

• Conservative treatments such as physical therapy, medications, or chiropractic care.
• Facet joint injections or nerve blocks.
• Surgical options, like spinal fusion or decompression surgery.
• Each alternative has its own benefits and risks, which should be discussed with a healthcare provider.

Patient Experience

• The procedure is generally well-tolerated with minimal discomfort due to local anesthesia.
• Patients may feel some pressure or mild pain during neurolytic agent injection.
• Post-procedure soreness is common but typically subsides quickly.
• Pain management and comfort measures (e.g., medications or ice packs) are provided as needed.