64633 Destruction by neurolytic agent, paravertebral facet joint nerve(s), with imaging guidance (fluoroscopy or CT); cervical or thoracic, single facet joint

Name of the Procedure:

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

Summary

This procedure involves using a chemical agent to destroy the nerve responsible for transmitting pain from a specific facet joint in the neck (cervical) or upper back (thoracic). Imaging technology such as fluoroscopy or CT scans is used to guide the process.

Purpose

The procedure aims to relieve chronic pain originating from the facet joint by interrupting the nerve signals. It is often performed when other treatments like medications or physical therapy fail to provide sufficient relief.

Indications

• Chronic neck or upper back pain attributed to facet joint dysfunction
• Persistent pain despite conservative treatments
• Confirmation of pain origin through diagnostic nerve blocks

Preparation

• Patients may be instructed to fast for several hours before the procedure.
• Some medications, especially blood thinners, might need to be adjusted or stopped.
• Pre-procedure imaging or diagnostic tests may be required to pinpoint the exact location of the pain.

Procedure Description

1. The patient lies in a prone position.
2. Local anesthesia is administered to numb the skin.
3. Using fluoroscopy or CT guidance, a needle is inserted near the targeted facet joint.
4. A neurolytic agent, such as phenol or alcohol, is injected to destroy the nerve.
5. Post-injection imaging confirms the agent's correct placement.

Duration

The procedure typically takes about 30 to 60 minutes.

Setting

It is usually performed in an outpatient clinic or a hospital's radiology department.

Personnel

• Interventional radiologist or pain management specialist
• Radiology technician
• Nursing staff

Risks and Complications

• Infection
• Bleeding or hematoma
• Allergic reaction to the neurolytic agent
• Temporary increase in pain
• Nerve damage or weakness (rare)

Benefits

Patients can expect significant pain relief, which can improve their overall quality of life. Pain relief typically begins within a few days.

Recovery

• Mild soreness at the injection site should be expected.
• Patients are usually advised to rest for 24 hours post-procedure.
• Normal activities can typically be resumed within a few days.
• Follow-up appointments may be necessary to assess pain relief and address any complications.

Alternatives

• Medications (NSAIDs, opioids)
• Physical therapy
• Facet joint injections
• Radiofrequency ablation
• Surgical options, such as spinal fusion

Patient Experience

During the procedure, patients may feel pressure or mild discomfort when the needle is positioned. Pain management is achieved through local anesthesia. Post-procedure soreness at the injection site is common, and effective pain relief measures will be prescribed.