Cervical translaminar epidural steroid injection

To establish medical necessity for spinal injections, the claim form must cite, and documentation must support, an appropriate diagnosis. Allowable diagnoses may vary by payer (Check with your particular payers for specifics.); however, commonly-allowable ICD-9-CM codes to establish medical necessity for 64479-64484 include intervertebral disc disorders (), spinal stenosis ( Spinal stenosis in cervical region , ), post-laminectomy syndrome (), and radiculitis ( Brachial neuritis or radiculitis NOS, Thoracic or lumbosacral neuritis or radiculitis, unspecified), among others.

An assessment by the BlueCross BlueShield Association Technology Evaluation Center (BCBSA, 2014) stated: "The choice of bone material for interbody fusion in [anterior cervical discectomy and fusion] ACDF has important clinical implications. Allograft bone has several drawbacks, including a minute (albeit unproven) risk of infectious disease transmission; possible immunological reaction to the allograft; and possible limited commercial availability of appropriate graft material. In contrast, the use of autograft bone in ACDF has potentially substantial morbidities at the harvest site, generally the iliac crest. These include moderate-to-severe, sometimes prolonged pain; deep infection; adjacent nerve and artery damage; and increased risk of stress fracture. Although there may be slight differences between autograft and allograft sources in the postoperative rate of union, clinical studies have demonstrated similar rates of postoperative fusion (90%–100%) and satisfactory outcomes for single-level, anterior-plated ACDF using either bone source. Thus, the choice of graft material involves a trade-off between the risks specific to autograft harvest versus those specific to use of allograft material."

The posterior column has a prominent role in the pain system , it is the first central relay in the nociceptive pathway. The first order afferent neuron carries sensory information to the second order neuron in the dorsal horn. The axon of the second order neuron, if it is a projection neuron and not an interneuron, then goes to the third order neuron in the thalamus . The thalamus is known as the "gateway to the cortex". The third order neuron then goes to the cerebral cortex . The afferent neurons are either A fibers or C fibers. A fibers are myelinated allowing for faster signal conduction. Among these there are A beta fibers which are faster and carry information about non-painful touch and A delta fibers which are slower and thinner than the A beta fibers. The C fibers are not myelinated and therefore slower. [10] C fibers that carry nociceptive signals can be divided into two types: fibers that contain neuropeptides , like substance P , and fibers that do not contain neuropeptides. [22] The two types terminate in very different areas. Non-peptidergic C fibers are linked to the skin, where they innervate the epidermis while peptidergic C fibers innervate other tissues and deeper parts of the skin. [10]

Cervical translaminar epidural steroid injection

cervical translaminar epidural steroid injection


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