Destruction by neurolytic agent, paravertebral facet joint nerve(s), with imaging guidance (fluoroscopy or CT); lumbar or sacral, each additional facet joint (List separately in addition to code for primary procedure)
CPT4 code
Name of the Procedure:
Destruction by neurolytic agent, paravertebral facet joint nerve(s), with imaging guidance (fluoroscopy or CT); lumbar or sacral, each additional facet joint (List separately in addition to code for primary procedure)
Summary
In this procedure, a neurolytic agent is used to destroy nerve tissues in the lumbar or sacral region of the spine that are causing pain. Imaging techniques like fluoroscopy or CT scans guide the treatment. This document describes the additional procedure for each extra facet joint.
Purpose
This procedure is designed to relieve chronic pain caused by inflamed or dysfunctional facet joints in the lumbar or sacral region of the spine. The primary goal is to reduce pain and improve mobility and quality of life.
Indications
Patients who suffer from persistent lower back pain due to conditions like facet joint syndrome, arthritis, or injury may benefit from this procedure. Candidates typically have not responded sufficiently to conservative treatments like physical therapy and medication.
Preparation
Patients are usually instructed to fast for a few hours before the procedure and may need to adjust their medications as advised by their healthcare provider. Diagnostic imaging tests such as MRI or CT scans are often performed beforehand to pinpoint the exact location of the pain.
Procedure Description
- The patient lies on an examination table.
- Local anesthesia or sedation is administered to minimize discomfort.
- Using imaging guidance (fluoroscopy or CT), a needle is precisely guided to the targeted facet joint.
- A neurolytic agent (typically a chemical agent like alcohol or phenol) is injected to destroy the nerve tissues causing pain.
- If more than one facet joint is being treated, additional injections are made accordingly.
Duration
The procedure usually takes 30 to 60 minutes, depending on the number of facet joints being treated.
Setting
The procedure is typically performed in an outpatient clinic, imaging center, or hospital.
Personnel
The healthcare team generally includes an interventional pain specialist or radiologist, a nurse, and possibly an anesthesiologist.
Risks and Complications
Common risks include temporary pain at the injection site, localized bleeding, or infection. Rare complications might include nerve damage, allergic reactions to the neurolytic agent, or prolonged numbness.
Benefits
The primary benefit is significant relief from chronic pain, often noticeable within a few days to a week. Improvement in mobility and the ability to perform daily activities is also expected.
Recovery
Post-procedure, patients are usually monitored for a short period and then discharged. They are advised to rest for a day and can typically resume normal activities within a few days. Follow-up appointments are important to assess the success of the treatment and to determine if additional interventions are required.
Alternatives
Other treatment options include physical therapy, oral medications, nerve blocks, radiofrequency ablation, and surgical interventions. The choice of treatment depends on the specific condition, the patient's overall health, and the severity of symptoms.
Patient Experience
During the procedure, patients might feel mild discomfort or pressure at the injection site. Post-procedure pain management strategies include over-the-counter pain relievers and ice packs. Most patients report a gradual decrease in pain and an improvement in function over several days.