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 Cystic liquid is then withdrawn, and decrease in cyst volume documented by imaging.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 and clinical classification codes for this guidance

Your responsibility

This guidance represents the view of NICE, arrived at after careful consideration of the evidence available. When exercising their judgement, healthcare professionals are expected to take this guidance fully into account, and specifically any special arrangements relating to the introduction of new interventional procedures. The guidance does not override the individual responsibility of healthcare professionals to make decisions appropriate to the circumstances of the individual patient, in consultation with the patient and/or guardian or carer. 

All problems (adverse events) related to a medicine or medical device used for treatment or in a procedure should be reported to the Medicines and Healthcare products Regulatory Agency using the Yellow Card Scheme.

Commissioners and/or providers have a responsibility to implement the guidance, in their local context, in light of their duties to have due regard to the need to eliminate unlawful discrimination, advance equality of opportunity, and foster good relations. Nothing in this guidance should be interpreted in a way that would be inconsistent with compliance with those duties. Providers should ensure that governance structures are in place to review, authorise and monitor the introduction of new devices and procedures.

Commissioners and providers have a responsibility to promote an environmentally sustainable health and care system and should assess and reduce the environmental impact of implementing NICE recommendations wherever possible.