64495 Injection(s), diagnostic or therapeutic agent, paravertebral facet (zygapophyseal) joint (or nerves innervating that joint) with image guidance (fluoroscopy or CT), lumbar or sacral; third and any additional level(s) (List separately in addition to code f

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; third and any additional level(s)

Summary

This procedure involves injecting a diagnostic or therapeutic agent into the facet joints or the nerves around them in the lumbar or sacral spine using image guidance, such as fluoroscopy or CT scans. It is used to alleviate pain or diagnose issues related to these joints.

Purpose

This procedure addresses chronic pain associated with lumbar and sacral facet joints, often due to arthritis, injury, or other degenerative conditions. The goals are to reduce pain, improve function, and help diagnose the specific source of pain.

Indications

• Chronic lower back pain not responsive to conservative treatments.
• Suspected facet joint syndrome.
• Chronic pain due to arthritis or degenerative spine conditions.
• Patients who have had positive responses to previous diagnostic facet joint injections.

Preparation

• Patients may need to fast for a few hours before the procedure.
• Medications, especially blood thinners, might need adjustment beforehand.
• Pre-procedure imaging studies and blood tests may be required.

Procedure Description

1. The patient is positioned, usually lying face down, on the procedure table.
2. The targeted area is cleaned and sterilized.
3. Local anesthetic is applied to numb the skin and deeper tissues.
4. Using fluoroscopy or CT for guidance, the doctor inserts a needle into the facet joint or the surrounding nerves.
5. A diagnostic agent (like a contrast dye) or a therapeutic agent (like a corticosteroid) is injected.
6. The needle is withdrawn, and a small bandage is applied.

Duration

Typically, the procedure takes about 15-30 minutes.

Setting

This procedure is generally performed in an outpatient clinic, a hospital radiology suite, or a surgical center.

Personnel

• Interventional radiologist or pain management specialist.
• Nurses.
• Radiologic technologist.

Risks and Complications

Common risks:

• Infection.
• Bleeding or bruising at the injection site.
• Temporary increase in pain.

Rare risks:

• Allergic reaction to the injected agent or contrast dye.
• Nerve damage.
• Spinal headache.

Benefits

• Potential relief from chronic pain, usually within a few days.
• Diagnostic clarity regarding the source of pain.
• Improved mobility and quality of life.

Recovery

• Rest for the remainder of the day post-procedure.
• Avoid strenuous activities for at least 24 hours.
• Follow-up appointment to assess pain relief and discuss further treatment.

Alternatives

• Physical therapy.
• Oral pain medications, including NSAIDs and muscle relaxants.
• Other types of spine injections, like epidural steroid injections.
• Surgical options in severe cases.

Patient Experience

• Mild discomfort or pressure during injection.
• Possible short-term numbness or weakness due to local anesthesia.
• Post-procedure soreness at the injection site, managed with ice packs and over-the-counter pain medications.
• Pain relief may be noticed within a few days.