CPT® Code 72255

1. Indications

Myelography is indicated for a variety of conditions affecting the spinal cord and its surrounding structures. The following are the explicitly provided indications for performing thoracic myelography:

• Intervertebral Disc Herniation - A condition where the disc material protrudes and may compress spinal nerves or the spinal cord.
• Meningeal Inflammation - Inflammation of the protective membranes covering the brain and spinal cord, which can lead to various neurological symptoms.
• Spinal Stenosis - A narrowing of the spinal canal that can cause pressure on the spinal cord and nerves, leading to pain and neurological deficits.
• Spinal Tumors - Abnormal growths within or around the spinal cord that may require evaluation for diagnosis and treatment planning.
• Other Spinal Lesions - This includes lesions caused by infections or previous trauma that may affect spinal function and health.

2. Procedure

The procedure for thoracic myelography involves several critical steps to ensure accurate imaging and patient safety. The following procedural steps are outlined:

• Step 1: Patient Preparation - The patient is positioned appropriately, and the area of the back where the needle will be inserted is cleaned and sterilized to minimize the risk of infection. The patient may be asked to lie on their side or in a sitting position, depending on the physician's preference.
• Step 2: Anesthesia Administration - Local anesthesia is administered to numb the area where the needle will be inserted. This helps to reduce discomfort during the procedure.
• Step 3: Needle Insertion - A spinal needle is carefully inserted into the subarachnoid space of the thoracic region of the spine. The physician uses fluoroscopic guidance to ensure accurate placement of the needle.
• Step 4: Contrast Material Injection - Once the needle is correctly positioned, a contrast agent is injected into the subarachnoid space. This contrast material enhances the visibility of the spinal structures during imaging.
• Step 5: Real-Time Imaging - As the contrast material flows through the spinal canal, real-time fluoroscopic X-ray imaging is performed. The radiologist observes the movement of the contrast to evaluate the spinal cord, nerve roots, and surrounding structures for any abnormalities.
• Step 6: Permanent Imaging - In addition to real-time imaging, permanent X-ray images may be taken for further analysis and documentation of the findings.
• Step 7: Needle Removal - After the imaging is complete, the needle is carefully removed, and pressure is applied to the insertion site to prevent bleeding.

3. Post-Procedure

After the thoracic myelography procedure, patients are typically monitored for a short period to ensure there are no immediate complications, such as headache or bleeding at the injection site. It is common for patients to experience some discomfort or mild headache following the procedure, which can usually be managed with over-the-counter pain relief. Patients are often advised to stay hydrated and may be instructed to rest for a certain period. Follow-up appointments may be scheduled to discuss the results of the imaging and any necessary further evaluations or treatments based on the findings.