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; third and any additional level(s)

Summary

This procedure involves injecting a diagnostic or therapeutic agent into the paravertebral facet joints or the nerves that supply these joints in the cervical (neck) or thoracic (upper back) spine. The process uses imaging guidance, either fluoroscopy (live X-ray) or CT (computed tomography) scan, to ensure precise placement of the injection.

Purpose

The procedure aims to alleviate pain or diagnose issues in the cervical or thoracic facet joints. The expected outcomes include reduced pain, improved mobility, and identification of pain sources for further treatment.

Indications

• Chronic neck or upper back pain suspected to originate from the facet joints
• Pain that has not responded to conservative treatments like physical therapy or medications
• Patients requiring diagnostic confirmation of facet joint involvement
• Individuals experiencing symptoms such as localized tenderness, muscle spasms, or limited range of motion

Preparation

• Patients may need to fast for several hours before the procedure.
• Medications, particularly blood thinners, may need to be adjusted or paused.
• A thorough medical history and physical examination will be conducted.
• Pre-procedure imaging tests like X-rays or MRI may be required to plan the injection.

Procedure Description

1. The patient is positioned appropriately, usually lying face-down.
2. The skin over the injection site is cleaned and sterilized.
3. Local anesthesia is administered to numb the area.
4. Using fluoroscopy or CT guidance, the needle is inserted into the targeted facet joint or nerve.
5. Once positioned correctly, the diagnostic or therapeutic agent is injected.
6. The needle is removed, and a bandage is applied to the site.

Duration

The procedure typically takes about 30 to 60 minutes, depending on the number of levels treated.

Setting

The procedure is usually performed in an outpatient clinic or a surgical center equipped with fluoroscopy or CT imaging technology.

Personnel

• Interventional radiologist or pain management specialist
• Nurses or medical assistants
• Radiologic technologist
• Anesthesiologist (if sedation is required)

Risks and Complications

• Infection at the injection site
• Bleeding or hematoma
• Allergic reaction to the injected agent
• Temporary increase in pain
• Nerve damage or numbness
• Rare complications like pneumothorax (collapsed lung)

Benefits

• Pain relief and improved function
• Diagnostic clarity regarding pain sources
• Potential to avoid more invasive surgical procedures
• Benefits are often realized within a few days and can last for weeks to months

Recovery

• Post-procedure monitoring for 30 minutes to an hour
• Ice packs on the injection site to reduce swelling
• Mild soreness may be experienced for a few days
• Avoid strenuous activities for 24 to 48 hours
• Follow-up appointment for assessment and further treatment planning

Alternatives

• Oral or topical pain medications
• Physical therapy
• Chiropractic care
• More invasive surgical interventions if conservative measures fail
• The pros of this procedure include targeted treatment and diagnostic accuracy; cons may include the need for repeat injections and procedural risks.

Patient Experience

• Patients may feel a pinch or mild discomfort during the injection.
• Post-procedure soreness is common but manageable with over-the-counter pain relief.
• Most patients report significant improvement in symptoms within a few days.
• Clear communication with the healthcare team can help address concerns and optimize comfort.