The National Institute for Health and Clinical Excellence (NICE) has issued full guidance to the NHS in England, Wales, Scotland and Northern Ireland on therapeutic percutaneous image-guided aspiration of spinal cord cysts.


Image guided needle aspiration of cysts can be used as part of a diagnostic work up with aspirate analysed by laboratory testing. Aspiration can also be used as a therapeutic procedure with the intent of decreasing cyst volume to relieve symptoms caused by pressure on the spinal cord.

The procedure is usually undertaken under local anaesthesia. A small gauge needle is inserted into the cysts using imaging guidance with nearly real-time visualisation where available. A range of image guidance modalities have been used as part of this procedure. Cystic liquid is then withdrawn, and decrease in cyst volume documented by imaging. Where cysts develop at more than one spinal level, more than one aspiration procedures may be needed.

Coding recommendations

A48.2 Aspiration of lesion of spinal cord

Y53.- Approach to organ under image control

Note: Codes within category Y53.- are used as secondary codes to classify interventions that are percutaneous and require some form of image control: if the method of image control is unspecified, Y53.9 Unspecified approach to organ under image control is assigned.