# Synovial Cyst rupture



## rjburd68 (Jun 5, 2009)

We need advice or confirmation on this: We are thinking that 77002(fluoro), 62268(percutaneous aspiration spinal cord cyst) as the procedure codes.

FROM A LEFT L5 - S1 FACET APPROACH:
1. Fluoroscopic-guided synovial
cyst rupture.

TECHNIQUE: After obtaining informed, written consent,
the back is prepped, 
draped and anesthetized in sterile fashion.
Under fluoroscopic guidance, 
local anesthesia is applied to the
medial branch nerves above and below the 
level of the joint. Under
fluoroscopic guidance, a 22g needle is advanced 
into the joint with
aspiration of approximately 1 mL of synovial fluid. 
Following this,
instillation of contrast is performed, determining needle 
location to
be within the joint. Subsequently, approximately 2-3 mL of 

preservative-free 1% lidocaine are instilled into the joint: the
solution was 
allowed to dwell for 5 minutes. The joint was
re-aspirated. Using 
non-bacteriostatic preservative-free saline, the
joint and cyst are injected 
with resistance and then loss of
resistance, indicating cyst rupture. 
Following this, 1 mL of
preservative free Celestone was slowly injected into 
the joint. A
small amount of contrast was again instilled into the joint. 
The
needle was removed. The patient tolerated the procedure well and left
the 
department in unchanged condition.

FINDINGS: Images demonstrate
the needles at the positions for L5 and S1 
medial branch blocks, as
well as within the appropriate facet joint. 
Opacification of the
synovial cyst is seen during contrast instillation. 
Contrast extends
beyond the original boundary of the cyst on the infusion of 
contrast
after cyst rupture, confirming rupture of the cyst.

IMPRESSION:
Successful left L5-S1 synovial cyst rupture and instillation of 

preservative free Celestone, as outlined above.

Any input is greatly appreciated.


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## mkstager (Jun 23, 2010)

*coder*

Did you ever get a reply on this question? Because I have the same question..


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