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L4-5 Synovial Cyst

Date: Aug 22, 2018

Question:

"Utilizing CT and CT fluoroscopic guidance, a 3.5 in 22 gauge spinal needle was advanced to the right L4-5 zygapophyseal joint. Contrast injection confirmed communication with the right L4-5 synovial cyst. Next, utilizing CT and CT fluoroscopic guidance, a 12 gauge Bonopty cannula was advanced through the right L4 laminotomy into the right L4-5 synovial cyst. Attempt at aspiration of the synovial cyst through the Bonopty cannula yielded no synovial fluid. Next, disruption of the cyst was performed via injection of the Bonopty cannula. There was contrast opacification in both the epidural space and in the intrathecal sac. Therefore, steroid/local anesthetic cocktail injection was not performed. Next, approximately 0.2 mL of Tisseel fibrin saleant was injected into the synovial cyst via a 15 cm 20 gauge Chiba needle coaxially through the translaminar cannula. The spinal needle and biopsy cannula were removed with continuous aspiration." How would you code this procedure for a L4-5 synovial cyst?

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