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Wang Y, Xu Y, Kang J, Fritz J, Iordachita I. Simulation-based Flexible Needle Control with Single-core FBG Feedback for Spinal Injections. IEEE TRANSACTIONS ON MEDICAL ROBOTICS AND BIONICS 2024; 6:1073-1083. [PMID: 39131204 PMCID: PMC11315370 DOI: 10.1109/tmrb.2024.3421630] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/13/2024]
Abstract
Objective We present a general framework of simultaneous needle shape reconstruction and control input generation for robot-assisted spinal injection procedures, without continuous imaging feedback. Methods System input-output mapping is generated with a real-time needle-tissue interaction simulation, and single-core FBG sensor readings are used as local needle shape feedback within the same simulation framework. FBG wavelength shifts due to temperature variation is removed by exploiting redundancy in fiber arrangement. Results Targeting experiments performed on both plastisol lumbar phantoms as well as an ex vivo porcine lumbar section achieved in-plane tip errors of 0.6 ± 0.3 mm and 1.6 ± 0.9 mm , and total tip errors of 0.9 ± 0.7 mm and 2.1 ± 0.8 mm for the two testing environments. Significance Our clinically inspired control strategy and workflow is self-contained and not dependent on the modality of imaging guidance. The generalizability of the proposed approach can be applied to other needle-based interventions where medical imaging cannot be reliably utilized as part of a closed-loop control system for needle guidance.
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Affiliation(s)
- Yanzhou Wang
- Department of Mechanical Engineering and Laboratory for Computational Sensing and Robotics, Johns Hopkins University, Baltimore, Maryland, USA
| | - Yangsheng Xu
- Department of Mechanical Engineering, Johns Hopkins University, Baltimore, Maryland, USA
| | - Jiarong Kang
- Department of Mechanical Engineering, Johns Hopkins University, Baltimore, Maryland, USA
| | - Jan Fritz
- Department of Radiology, New York University, New York City, New York, USA
| | - Iulian Iordachita
- Department of Mechanical Engineering and Laboratory for Computational Sensing and Robotics, Johns Hopkins University, Baltimore, Maryland, USA
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Sharma S, Kalyani N, Dutta T, Velázquez-González JS, Llamas-Garro I, Ung B, Bas J, Dubey R, Mishra SK. Optical Devices for the Diagnosis and Management of Spinal Cord Injuries: A Review. BIOSENSORS 2024; 14:296. [PMID: 38920599 PMCID: PMC11201428 DOI: 10.3390/bios14060296] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/14/2024] [Revised: 05/21/2024] [Accepted: 06/02/2024] [Indexed: 06/27/2024]
Abstract
Throughout the central nervous system, the spinal cord plays a very important role, namely, transmitting sensory and motor information inwardly so that it can be processed by the brain. There are many different ways this structure can be damaged, such as through traumatic injury or surgery, such as scoliosis correction, for instance. Consequently, damage may be caused to the nervous system as a result of this. There is no doubt that optical devices such as microscopes and cameras can have a significant impact on research, diagnosis, and treatment planning for patients with spinal cord injuries (SCIs). Additionally, these technologies contribute a great deal to our understanding of these injuries, and they are also essential in enhancing the quality of life of individuals with spinal cord injuries. Through increasingly powerful, accurate, and minimally invasive technologies that have been developed over the last decade or so, several new optical devices have been introduced that are capable of improving the accuracy of SCI diagnosis and treatment and promoting a better quality of life after surgery. We aim in this paper to present a timely overview of the various research fields that have been conducted on optical devices that can be used to diagnose spinal cord injuries as well as to manage the associated health complications that affected individuals may experience.
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Affiliation(s)
- Sonika Sharma
- Department of Physics, Graphic Era Hill University, Dehradun 248002, Uttarakhand, India;
| | - Neeti Kalyani
- Department of Biotechnology and Biomedicine, Denmark Technical University, 2800 Kongens Lyngby, Denmark;
| | - Taposhree Dutta
- Department of Chemistry, Indian Institute of Engineering Science and Technology, Shibpur, Howarh 711103, West Bengal, India;
| | - Jesús Salvador Velázquez-González
- Navigation and Positioning, Center Technologic de Telecomunicacions de Catalunya (CTTC), Avinguda Carl Friedrich Gauss, 11, 08860 Castelldefels, Spain; (J.S.V.-G.); (I.L.-G.)
| | - Ignacio Llamas-Garro
- Navigation and Positioning, Center Technologic de Telecomunicacions de Catalunya (CTTC), Avinguda Carl Friedrich Gauss, 11, 08860 Castelldefels, Spain; (J.S.V.-G.); (I.L.-G.)
| | - Bora Ung
- Electrical Engineering Department, Ecole de Technologie Superieure, Montreal, QC H3C 1K3, Canada;
| | - Joan Bas
- Space and Resilient Communications and Systems (SRCOM), Center Technologic de Telecomunicacions de Catalunya (CTTC), Avinguda Carl Friedrich Gauss, 11, 08860 Castelldefels, Spain;
| | - Rakesh Dubey
- Institute of Physics, University of Szczecin, 70-453 Szczecin, Poland;
| | - Satyendra K. Mishra
- Space and Resilient Communications and Systems (SRCOM), Center Technologic de Telecomunicacions de Catalunya (CTTC), Avinguda Carl Friedrich Gauss, 11, 08860 Castelldefels, Spain;
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Said N, Amrhein TJ, Joshi AB, N NCN, Kranz PG. Facets of facet joint interventions. Skeletal Radiol 2023; 52:1873-1886. [PMID: 36245007 DOI: 10.1007/s00256-022-04184-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2022] [Revised: 09/06/2022] [Accepted: 09/10/2022] [Indexed: 02/02/2023]
Abstract
Facet joint (FJ) disease is a common cause of axial low back pain with many minimally invasive image-guided treatment options. This article discusses fluoroscopic and CT-guided intraarticular FJ injections, medial branch (MB) radiofrequency ablation (RFA), and lumbar facet synovial cyst (LFSC) aspiration, rupture, or fenestration. Additionally, the article will highlight medial branch blocks (MBBs) utilized to diagnose facet-mediated pain and to predict outcomes to RFA.
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Affiliation(s)
- Nicholas Said
- Department of Radiology, Duke University Health System, 2301 Erwin Road, Box 3808, Durham, NC, 27110, USA.
| | - Timothy J Amrhein
- Department of Radiology, Duke University Health System, 2301 Erwin Road, Box 3808, Durham, NC, 27110, USA
| | - Anand B Joshi
- Department of Orthopaedic Surgery, Emory University, Atlanta, GA, USA
| | - Nicholas C Nacey N
- Department of Radiology and Medical Imaging, University of Virginia, 1215 Lee St, PO Box 800170, Charlottesville, VA, 22908, USA
| | - Peter G Kranz
- Department of Radiology, Duke University Health System, 2301 Erwin Road, Box 3808, Durham, NC, 27110, USA
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Stratchko L, Pitts J, Symanski J, Ross A, Davis K, Monroe E, Rosas H. Rationale for fluoroscopic guidance in spine injections. Skeletal Radiol 2023; 52:1841-1851. [PMID: 36102947 DOI: 10.1007/s00256-022-04181-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2022] [Revised: 09/01/2022] [Accepted: 09/01/2022] [Indexed: 02/02/2023]
Abstract
Spine injections are commonly performed in the treatment of back pain. The purpose of this article is to review the current literature surrounding image guided spine injections focusing on scenarios where fluoroscopic guidance can be advantageous in addition to discussing similarities among the different modalities.
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Affiliation(s)
- Lindsay Stratchko
- School of Medicine and Public Health Department of Radiology, University of Wisconsin, 600 Highland Ave., Madison, WI, 53792, USA.
| | - Jennifer Pitts
- School of Medicine and Public Health Department of Radiology, University of Wisconsin, 600 Highland Ave., Madison, WI, 53792, USA
| | - John Symanski
- School of Medicine and Public Health Department of Radiology, University of Wisconsin, 600 Highland Ave., Madison, WI, 53792, USA
| | - Andrew Ross
- School of Medicine and Public Health Department of Radiology, University of Wisconsin, 600 Highland Ave., Madison, WI, 53792, USA
| | - Kirkland Davis
- School of Medicine and Public Health Department of Radiology, University of Wisconsin, 600 Highland Ave., Madison, WI, 53792, USA
| | - Eric Monroe
- School of Medicine and Public Health Department of Radiology, University of Wisconsin, 600 Highland Ave., Madison, WI, 53792, USA
| | - Humberto Rosas
- School of Medicine and Public Health Department of Radiology, University of Wisconsin, 600 Highland Ave., Madison, WI, 53792, USA
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5
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Dalili D, Isaac A, Fritz J. MRI-guided sacroiliac joint injections in children and adults: current practice and future developments. Skeletal Radiol 2023; 52:951-965. [PMID: 36006462 DOI: 10.1007/s00256-022-04161-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2022] [Revised: 08/10/2022] [Accepted: 08/11/2022] [Indexed: 02/02/2023]
Abstract
Common etiologies of low back pain include degenerative arthrosis and inflammatory arthropathy of the sacroiliac joints. The diagnostic workup revolves around identifying and confirming the sacroiliac joints as a pain generator. Diagnostic sacroiliac joint injections often serve as functional additions to the diagnostic workup through eliciting a pain response that tests the hypothesis that the sacroiliac joints do or do not contribute to the patient's pain syndrome. Therapeutic sacroiliac joint injections aim to provide medium- to long-term relief of symptoms and reduce inflammatory activity and, ultimately, irreversible structural damage. Ultrasonography, fluoroscopy, computed tomography, and magnetic resonance imaging (MRI) may be used to guide sacroiliac joint injections. The populations that may benefit most from MRI-guided sacroiliac joint procedures include children, adolescents, adults of childbearing age, and patients receiving serial injections due to the ability of interventional MRI to avoid radiation exposure. Most clinical wide-bore MRI systems can be used for MRI-guided sacroiliac joint injections. Turbo spin echo pulse sequences optimized for interventional needle display visualize the needle tip with an error margin of < 1 mm or less. Published success rates of intra-articular sacroiliac joint drug delivery with MRI guidance range between 87 and 100%. The time required for MR-guided sacroiliac joint injections in adults range between 23-35 min and 40 min in children. In this article, we describe techniques for MRI-guided sacroiliac joint injections, share our practice of incorporating interventional MRI in the care of patients with sacroiliac joint mediated pain, discuss the rationales, benefits, and limitations of interventional MRI, and conclude with future developments.
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Affiliation(s)
- Danoob Dalili
- Academic Surgical Unit, South West London Elective Orthopaedic Centre (SWLEOC), Dorking Road, KT18 7EG, London, UK
| | - Amanda Isaac
- School of Biomedical Engineering and Imaging Sciences, King's College London, London, UK
- Department of Diagnostic and Interventional Radiology, Guy's and St Thomas' Hospitals NHS Foundation Trust, London, UK
| | - Jan Fritz
- Department of Radiology, New York University Grossman School of Medicine, 660 1st Ave, 3rd Floor, Rm 313, New York, NY, 10016, USA.
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Bauones S, Cazzato RL, Dalili D, Koch G, Garnon J, Gantzer J, Kurtz JE, Gangi A. Precision pain management in interventional radiology. Clin Radiol 2023; 78:270-278. [PMID: 36931782 DOI: 10.1016/j.crad.2022.09.135] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2022] [Accepted: 09/15/2022] [Indexed: 03/17/2023]
Abstract
Pain is a common manifestation of several benign and malignant conditions. Inadequate response to conservative therapies is often succeeded by incremental use of analgesics and opioids; however, such an approach is often ineffective, not well tolerated by patients, and carries the risk of addiction leading to the opioid crisis. Implementing minimally invasive percutaneous procedures, performed by interventional radiologists has proven to be successful in providing safe, effective, and patient-specific therapies across a wide range of painful conditions. In the present narrative review, we will review the repertoire of minimally invasive imaging guided interventions, which have been successfully used to treat common painful benign and malignant conditions. We briefly describe each technique, common indications, and expected results.
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Affiliation(s)
- S Bauones
- Medical Imaging Administration, Musculoskeletal Imaging Department (AlAwaji, Banuones), King Fahad Medical City, Riyadh, Saudi Arabia; Radiology and Medical Imaging Department (Alsaadi), College of Applied Medical Sciences, Prince Sattam Bin Abdulaziz Alkharj, Saudi Arabia
| | - R L Cazzato
- Department of Interventional Radiology, University Hospital of Strasbourg, 67000, Strasbourg, France; Department of Medical Oncology, Strasbourg-Europe Cancer Institute (ICANS), 67033, Strasbourg, France.
| | - D Dalili
- Academic Surgical Unit, South West London Elective Orthopaedic Centre (SWLEOC), Dorking Road, Epsom, London, KT18 7EG, UK; Department of Diagnostic and Interventional Radiology, Epsom and St Helier University Hospitals NHS Trust, Dorking Road, Epsom, KT18 7EG, UK
| | - G Koch
- Department of Interventional Radiology, University Hospital of Strasbourg, 67000, Strasbourg, France; Institut of Human Anatomy, University Hospital of Strasbourg, 67000, Strasbourg, France
| | - J Garnon
- Department of Interventional Radiology, University Hospital of Strasbourg, 67000, Strasbourg, France
| | - J Gantzer
- Department of Medical Oncology, Strasbourg-Europe Cancer Institute (ICANS), 67033, Strasbourg, France; Department of Cancer and Functional Genomics INSERM UMR_S1258, Institute of Genetics and of Molecular and Cellular Biology, 67400, Illkirch, France
| | - J E Kurtz
- Department of Medical Oncology, Strasbourg-Europe Cancer Institute (ICANS), 67033, Strasbourg, France
| | - A Gangi
- Department of Interventional Radiology, University Hospital of Strasbourg, 67000, Strasbourg, France; School of Biomedical Engineering and Imaging Sciences, King's College London, Strand, London, WC2R 2LS, UK
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Wang Y, Xu Y, Kwok KW, Iordachita I. In Situ Flexible Needle Adjustment Towards MRI-Guided Spinal Injections Based on Finite Element Simulation. ... INTERNATIONAL SYMPOSIUM ON MEDICAL ROBOTICS. INTERNATIONAL SYMPOSIUM ON MEDICAL ROBOTICS 2023; 2023:10.1109/ismr57123.2023.10130218. [PMID: 38031531 PMCID: PMC10686575 DOI: 10.1109/ismr57123.2023.10130218] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/01/2023]
Abstract
This paper investigates the possibility of robotically performing in situ needle manipulations to correct the needle tip position in the setting of robot-assisted, MRI-guided spinal injections, where real time MRI images cannot be effectively used to guide the needle. Open-loop control of the needle tip is derived from finite element simulation, and the proposed method is tested with ex vivo animal muscle tissues and validated by cone beam computed tomography. Preliminary results have shown promise of performing needle tip correction in situ to improve needle insertion accuracy when real-time feedback is not readily available.
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Affiliation(s)
- Yanzhou Wang
- Department of Mechanical Engineering and Laboratory for Computational Sensing and Robotics, Johns Hopkins University, Baltimore, Maryland, USA
| | - Yangsheng Xu
- Department of Mechanical Engineering and Laboratory for Computational Sensing and Robotics, Johns Hopkins University, Baltimore, Maryland, USA
| | - Ka-Wai Kwok
- Department of Mechanical Engineering, The University of Hong Kong, Hong Kong
| | - Iulian Iordachita
- Department of Mechanical Engineering and Laboratory for Computational Sensing and Robotics, Johns Hopkins University, Baltimore, Maryland, USA
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Wang Y, Kwok KW, Cleary K, Taylor RH, Iordachita I. Flexible Needle Bending Model for Spinal Injection Procedures. IEEE Robot Autom Lett 2023; 8:1343-1350. [PMID: 37637101 PMCID: PMC10448781 DOI: 10.1109/lra.2023.3239310] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/29/2023]
Abstract
An in situ needle manipulation technique used by physicians when performing spinal injections is modeled to study its effect on needle shape and needle tip position. A mechanics-based model is proposed and solved using finite element method. A test setup is presented to mimic the needle manipulation motion. Tissue phantoms made from plastisol as well as porcine skeletal muscle samples are used to evaluate the model accuracy against medical images. The effect of different compression models as well as model parameters on model accuracy is studied, and the effect of needle-tissue interaction on the needle remote center of motion is examined. With the correct combination of compression model and model parameters, the model simulation is able to predict needle tip position within submillimeter accuracy.
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Affiliation(s)
- Yanzhou Wang
- Department of Mechanical Engineering and Laboratory for Computational Sensing and Robotics, Johns Hopkins University, Baltimore, Maryland, USA
| | - Ka-Wai Kwok
- Department of Mechanical Engineering, The University of Hong Kong, Hong Kong, China
| | - Kevin Cleary
- Sheikh Zayed Institute for Pediatric Surgical Innovation, Children's National Hospital, Washington, DC, USA
| | - Russell H Taylor
- Department of Computer Science and Laboratory for Computational Sensing and Robotics, Johns Hopkins University, Baltimore, Maryland, USA
| | - Iulian Iordachita
- Department of Mechanical Engineering and Laboratory for Computational Sensing and Robotics, Johns Hopkins University, Baltimore, Maryland, USA
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9
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Maeda M, Maeda N, Masuda K, Kamatani Y, Takamasa S, Tanaka Y. Ligamentum Flavum Rupture by Epidural Injection Using Ultrasound with SMI Method. Tomography 2023; 9:285-298. [PMID: 36828375 PMCID: PMC9964737 DOI: 10.3390/tomography9010023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2022] [Revised: 01/26/2023] [Accepted: 01/27/2023] [Indexed: 02/04/2023] Open
Abstract
The loss of resistance (LOR) method has been used exclusively to identify epidural space. It is difficult to find the epidural space without the risk of dural puncture. Various devices have been developed to improve the accuracy of the LOR method; however, no method has overcome the problems completely. Therefore, we devised a ligamentum flavum rupture method (LFRM) in which the needle tip is placed only on the ligamentum flavum during the epidural injection, and the injection pressure is used to rupture the ligamentum flavum and spread the drug into the epidural space. We confirmed the accuracy of this method using ultrasound with superb microvascular imaging (SMI) to visualize the epidural space. Here, we report two cases of 63-year-old and 90-year-old males. The 63-year-old patient presented with severe pain in his right buttock that extended to the posterior lower leg. The 90-year-old patient presented with intermittent claudication every 10 min. LFRM was performed, and SMI was used to confirm that the parenteral solution had spread into the epidural space. Our results indicate that LFRM can be used for interlaminar lumbar epidural steroid injections.
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Affiliation(s)
- Manabu Maeda
- Department of Orthopedics, Maeda Orthopaedic Clinic, Nara 630-8306, Japan
- Correspondence: ; Tel.: +81-742-24-5595
| | - Nana Maeda
- Department of Orthopedics, Maeda Orthopaedic Clinic, Nara 630-8306, Japan
| | - Keisuke Masuda
- Department of Orthopedics, Higashiosaka Medical Center, Osaka 578-8588, Japan
| | - Yoshiyuki Kamatani
- Department of Orthopedics, Saiseikai Nara Hospital, Nara 630-8145, Japan
| | - Shimizu Takamasa
- Department of Orthopedics, Nara Medical University, Nara 634-8521, Japan
| | - Yasuhito Tanaka
- Department of Orthopedics, Nara Medical University, Nara 634-8521, Japan
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Wang Y, Liu G, Li G, Cleary K, Iordachita I. An MR-Conditional Needle Driver for Robot-Assisted Spinal Injections: Design Modifications and Evaluations. ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL INTERNATIONAL CONFERENCE 2022; 2022:3307-3312. [PMID: 36086159 PMCID: PMC9490797 DOI: 10.1109/embc48229.2022.9871596] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
This paper introduces design modifications to our MR-Conditional, 2-degree-of-freedom (DOF), remotely-actuated needle driver for MRI-guided spinal injections. The new needle driver should better meet cleaning and sterilization guidelines needed for regulatory approval, preserve the sterile field during intraoperative needle attachment, and offer better ergonomics and intuitiveness when handling the device. Dy-namic and static force and torque required to properly install the needle driver onto our 4-DOF robot base are analyzed, which provide insight into the risks of intraoperative tool attachment in the setting of robot-assisted spinal injections under MRI guidance.
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Affiliation(s)
- Yanzhou Wang
- Department of Mechanical Engineering, Johns Hopkins University, Baltimore, MD 21211, USA
| | - Guanyun Liu
- Department of Mechanical Engineering, Johns Hopkins University, Baltimore, MD 21211, USA
| | - Gang Li
- Sheikh Zayed Institute for Pediatric Surgical Innovation, Children’s National Hospital, Washington, DC 20010, USA
| | - Kevin Cleary
- Sheikh Zayed Institute for Pediatric Surgical Innovation, Children’s National Hospital, Washington, DC 20010, USA
| | - Iulian Iordachita
- Department of Mechanical Engineering, Johns Hopkins University, Baltimore, MD 21211, USA
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Chae JS, Kim WJ, Jue MJ. Facet Joint Versus Transforaminal Epidural Steroid Injections in Patients With Cervical Radicular Pain due to Foraminal Stenosis: A Retrospective Comparative Study. J Korean Med Sci 2022; 37:e208. [PMID: 35762147 PMCID: PMC9239844 DOI: 10.3346/jkms.2022.37.e208] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2022] [Accepted: 05/24/2022] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND A cervical transforaminal epidural (TFE) steroid injection is a useful treatment option for cervical radicular pain, but it carries a small risk of catastrophic complications. Several studies have reported that cervical facet joint (FJ) steroid injection can reduce cervical radicular pain through an indirect epidural spread. The aim of this retrospective comparative study was to evaluate the pain scores and functional disability in subjects receiving cervical FJ or TFE steroid injection for the treatment of cervical radicular pain due to foraminal stenosis (FS). METHODS We selected 278 patients 18 years of age and older who underwent cervical FJ (n = 130) or TFE (n= 148) steroid injection for cervical radicular pain. The primary outcomes included pain scores and functional disability during hospital visits one, three, and six months after the initial injection. Secondary outcomes were the proportion of responders and Medication Quantification Scale (MQS) scores. Adverse events and variables correlating with effectiveness one month after the initial injection were also evaluated. RESULTS The Numeric Rating Scale and Neck Disability Index scores showed a significant improvement one, three, and six months after the initial injection in both groups, with no significant differences between the groups. No significant differences were observed in the success rates of the procedure one, three, and six months after the initial injection for either group. There were no significant differences in MQS between the groups during the follow-up period. Univariate and multivariate logistic regression analyses revealed that the injection method, age, sex, number of injections, FS severity, MQS, pain duration, and the presence of cervical disc herniation were not independent predictors of treatment success. CONCLUSION The efficacy of FJ steroid injection may not be inferior to that of TFE steroid injection in patients with cervical radicular pain due to FS.
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Affiliation(s)
- Ji Seon Chae
- Department of Anesthesiology and Pain Medicine, College of Medicine, Ewha Womans University, Seoul, Korea
| | - Won-Joong Kim
- Department of Anesthesiology and Pain Medicine, College of Medicine, Ewha Womans University, Seoul, Korea.
| | - Mi Jin Jue
- Department of Anesthesiology and Pain Medicine, College of Medicine, Ewha Womans University, Ewha Womans University Mokdong Hospital, Seoul, Korea
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Radiation dose of fluoroscopy-guided versus ultralow-dose CT-fluoroscopy-guided lumbar spine epidural steroid injections. Skeletal Radiol 2022; 51:1055-1062. [PMID: 34611727 DOI: 10.1007/s00256-021-03920-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2021] [Revised: 09/21/2021] [Accepted: 09/21/2021] [Indexed: 02/02/2023]
Abstract
OBJECTIVE Compare radiation dose of lumbar spine epidural steroid injections (ESIs) performed under fluoroscopy guidance and ultralow-dose CT-fluoroscopy guidance. MATERIALS AND METHODS Retrospective review of consecutive lumbar ESIs performed using fluoroscopy, between May 2017 and April 2019, and using ultralow-dose CT-fluoroscopy, between August 2019 and February 2021, was performed. Ultralow-dose CT-fluoroscopy technique omits a planning CT scan, utilizes CT-fluoroscopy, and minimizes radiation dose parameters. Patient characteristics (age, sex, height, weight, body mass index (BMI)), procedural characteristics (anatomic level, type of ESI, procedure time, pain reduction, complications, trainee participation), and radiation dose were compared. Chi-square tests and two-sample t-tests were performed for statistical analysis. RESULTS One hundred and forty-seven patients (mean age 55.8 ± 16.7; 85 women) underwent ESIs using fluoroscopy. Sixty-six patients (mean age 60.9 ± 16.7; 33 women) underwent ESIs using ultralow-dose CT-fluoroscopy. The effective dose for the fluoroscopy group was 0.30 mSv ± 0.34, compared to 0.15 mSV ± 0.11 for ultralow-dose CT-fluoroscopy (p < 0.001). The average age in the CT-fluoroscopy group was older (p = 0.04), and there was more trainee participation in the fluoroscopy group (p < 0.001); otherwise there was no statistically significant difference in patient or procedural characteristics between the conventional fluoroscopy group and the ultralow-dose CT-fluoroscopy group. There was no statistically significant difference in immediate post-procedure pain reduction between the groups (p = 0.16). Four intrathecal injections occurred only in the fluoroscopy group, though this difference was not significant (p = 0.18). CONCLUSION Ultralow-dose CT-fluoroscopy technique for image-guided lumbar spine ESIs can lower radiation dose compared to fluoroscopy-guided technique.
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Reuschel V, Scherlach C, Pfeifle C, Krause M, Struck MF, Hoffmann KT, Schob S. Treatment Effect of CT-Guided Periradicular Injections in Context of Different Contrast Agent Distribution Patterns. Diagnostics (Basel) 2022; 12:diagnostics12040787. [PMID: 35453835 PMCID: PMC9028051 DOI: 10.3390/diagnostics12040787] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2022] [Revised: 03/08/2022] [Accepted: 03/18/2022] [Indexed: 02/01/2023] Open
Abstract
Acutely manifesting radicular pain syndromes associated with degenerations of the lower spine are frequent ailments with a high rate of recurrence. Part of the conservative management are periradicular infiltrations of analgesics and steroids. The purpose of this study is to evaluate the dependence of the clinical efficacy of CT-guided periradicular injections on the pattern of contrast distribution and to identify the best distribution pattern that is associated with the most effective pain relief. Using a prospective study design, 161 patients were included in this study, ensuring ethical standards. Statistical analysis was performed, with the level of statistical significance set at p = 0.05. A total of 37.9% of patients experienced significant but not long-lasting (four weeks on average) complete pain relief. A total of 44.1% of patients experienced prolonged, subjectively satisfying pain relief of more than four weeks to three months. A total of 18% of patients had complete and sustained relief for more than six months. A significant correlation exists between circumferential, large area contrast distribution including the zone of action between the disc and affected nerve root contrast distribution pattern with excellent pain relief. Our results support the value of CT-guided contrast injection for achieving a good efficacy, and, if necessary, indicative repositioning of the needle to ensure a circumferential distribution pattern of corticosteroids for the sufficient treatment of radicular pain in degenerative spine disease.
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Affiliation(s)
- Vera Reuschel
- Institut für Neuroradiologie, Universitätsklinikum Leipzig AöR, Liebigstr. 20, 04103 Leipzig, Germany; (V.R.); (C.S.); (K.-T.H.)
- Institut für Diagnostische und Interventionelle Neuroradiologie, Universitätsmedizin Göttingen, Robert-Koch-Str. 40, 37075 Göttingen, Germany
| | - Cordula Scherlach
- Institut für Neuroradiologie, Universitätsklinikum Leipzig AöR, Liebigstr. 20, 04103 Leipzig, Germany; (V.R.); (C.S.); (K.-T.H.)
| | - Christian Pfeifle
- Klinik und Poliklinik für Orthopädie, Unfallchirurgie und Plastische Chirurgie, Universitätsklinikum Leipzig AöR, Liebigstr. 20, 04103 Leipzig, Germany;
| | - Matthias Krause
- Klinik und Poliklinik für Neurochirurgie, Universitätsklinikum Leipzig AöR, Liebigstr. 20, 04103 Leipzig, Germany;
| | - Manuel Florian Struck
- Klinik und Poliklinik für Anästhesiologie und Intensivtherapie, Universitätsklinikum Leipzig AöR, Liebigstr. 20, 04103 Leipzig, Germany;
| | - Karl-Titus Hoffmann
- Institut für Neuroradiologie, Universitätsklinikum Leipzig AöR, Liebigstr. 20, 04103 Leipzig, Germany; (V.R.); (C.S.); (K.-T.H.)
| | - Stefan Schob
- Abteilung für Neuroradiologie, Universitätsklinik und Poliklinik für Radiologie, Universitätsklinikum Halle (Saale) Ernst-Grube-Str. 40, 06120 Halle (Saale), Germany
- Correspondence: ; Tel.: +49-34-5557-2432
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Arora P, Kanthed P, Vyas N, Dey S. Minimally invasive pain and spine interventions for low backache. INDIAN JOURNAL OF PAIN 2022. [DOI: 10.4103/ijpn.ijpn_122_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
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Jeffrey R, Santosham R, Nagenthran G, Dev B, Mandava R, Vasanthraj P, Saravanan S. Qualitative assessment of chronic pain management in patients undergoing computed tomography-guided procedures. THE EGYPTIAN JOURNAL OF RADIOLOGY AND NUCLEAR MEDICINE 2021. [DOI: 10.1186/s43055-020-00390-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
To study the qualitative efficacy and safety of percutaneous pain management under CT guidance. The success rate of medical management for chronic pain in long term is very less. This study aids in evaluating the clinical success rate in each CT-guided pain management procedure we have done.
Results
Among the 60 patients, 39 (65%) were male patients and 21 (35%) were female patients. We did 40 celiac plexus neurolysis (66.7%), 13 radiofrequency ablations (21.6%), 4 stellate ganglion neurolysis (6.7%), and 3 trigeminal nerve neurolysis (5%). The average pre-procedural pain score in all the procedures was 7 which was significantly reduced to 1 in 24 h and 1 and 3 months.
Conclusion
Percutaneous pain management under CT guidance by virtue of its precise needle placement offers effective pain relief. It has a lower rate of complications, reduces the need for repeat procedures, and ultimately increases the quality of life.
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Wong O, Zhang G, Matthews H, Skalski M, Asadi H, Lalloo S, Kurda D. Image-guided spinal injection for pain management. J Med Imaging Radiat Oncol 2021; 66:79-91. [PMID: 34369081 DOI: 10.1111/1754-9485.13308] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2021] [Revised: 07/11/2021] [Accepted: 07/15/2021] [Indexed: 01/12/2023]
Abstract
Radiculopathy and spinal pain are debilitating conditions affecting millions of people worldwide each year. While most cases can be managed conservatively with physiotherapy and nonsteroidal anti-inflammatory medications, minimally invasive corticosteroid injections are the mainstay intervention for those not responsive to conservative treatment. Historically, spinal injections were performed in the absence of imaging guidance; however, imaging modalities, in particular fluoroscopy and computer tomography (CT), have become the standard of care in performing most of these procedures. Under imaging guidance, operators can accurately confirm needle placement and safely target localised pathologies.
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Affiliation(s)
- Osanna Wong
- Australian National University Medical School, Canberra, Australian Capital Territory, Australia
| | - George Zhang
- Department of Medical Imaging, The Canberra Hospital, Canberra, Australian Capital Territory, Australia
| | - Hayden Matthews
- Australian National University Medical School, Canberra, Australian Capital Territory, Australia
| | - Mathew Skalski
- Palmer College of Chiropractic - West Campus, San Jose, California, USA
| | - Hamed Asadi
- Department of Radiology, Austin Health, Melbourne, Victoria, Australia.,Department of Radiology, Monash Health, Melbourne, Victoria, Australia.,Deakin University, Geelong, Victoria, Australia
| | - Shivendra Lalloo
- Department of Medical Imaging, The Canberra Hospital, Canberra, Australian Capital Territory, Australia
| | - Dylan Kurda
- Australian National University Medical School, Canberra, Australian Capital Territory, Australia.,Department of Medical Imaging, The Canberra Hospital, Canberra, Australian Capital Territory, Australia
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Cañada-Soriano M, Priego-Quesada JI, Bovaira M, García-Vitoria C, Salvador Palmer R, Cibrián Ortiz de Anda R, Moratal D. Quantitative Analysis of Real-Time Infrared Thermography for the Assessment of Lumbar Sympathetic Blocks: A Preliminary Study. SENSORS 2021; 21:s21113573. [PMID: 34063768 PMCID: PMC8196638 DOI: 10.3390/s21113573] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/16/2021] [Revised: 05/09/2021] [Accepted: 05/19/2021] [Indexed: 12/28/2022]
Abstract
Lumbar sympathetic blocks (LSBs) are commonly performed to treat pain ailments in the lower limbs. LSBs involve injecting local anesthetic around the nerves. The injection is guided by fluoroscopy which is sometimes considered to be insufficiently accurate. The main aim was to analyze the plantar foot skin temperature data acquired while performing LSBs in patients with complex regional pain syndrome (CRPS) affecting the lower limbs. Forty-four LSBs for treating lower limb CRPS in 13 patients were assessed. Pain medicine physicians visualized the infrared thermography (IRT) video in real time and classified the performance depending on the observed thermal changes within the first 4 min. Thirty-two percent of the cases did not register temperature variations after lidocaine was injected, requiring the needle to be relocated. Differences between moments are indicated using the 95% confidence intervals of the differences (CI 95%), the Cohen effect size (ES) and the significance (p value). In successful cases, after injecting lidocaine, increases at minute 7 for the mean (CI 95% (1.4, 2.1 °C), p < 0.001 and ES = 0.5), at minute 5 for maximum temperature (CI 95% (2.3, 3.3 °C), p < 0.001 and ES = 0.6) and at minute 6 for SD (CI 95% (0.2, 0.3 °C), p < 0.001 and ES = 0.5) were observed. The results of our preliminary study showed that the measurement of skin temperature in real time by infrared thermography is valuable for assessing the success of lumbar sympathetic blocks.
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Affiliation(s)
- Mar Cañada-Soriano
- Applied Thermodynamics Department (DTRA), Universitat Politècnica de València, 46022 Valencia, Spain;
| | - José Ignacio Priego-Quesada
- Research Group in Sports Biomechanics (GIBD), Department of Physical Education and Sports, University of Valencia, Avda. Blasco Ibáñez, 15, 46010 Valencia, Spain
- Research Group in Medical Physics (GIFIME), Department of Physiology, University of Valencia, Avda. Blasco Ibáñez, 15, 46010 Valencia, Spain; (R.S.P.); (R.C.O.d.A.)
- Correspondence: (J.I.P.-Q.); (D.M.)
| | - Maite Bovaira
- Anaesthesia Department, Hospital Intermutual de Levante, Sant Antoni de Benaixeve, 46184 Valencia, Spain; (M.B.); (C.G.-V.)
| | - Carles García-Vitoria
- Anaesthesia Department, Hospital Intermutual de Levante, Sant Antoni de Benaixeve, 46184 Valencia, Spain; (M.B.); (C.G.-V.)
| | - Rosario Salvador Palmer
- Research Group in Medical Physics (GIFIME), Department of Physiology, University of Valencia, Avda. Blasco Ibáñez, 15, 46010 Valencia, Spain; (R.S.P.); (R.C.O.d.A.)
| | - Rosa Cibrián Ortiz de Anda
- Research Group in Medical Physics (GIFIME), Department of Physiology, University of Valencia, Avda. Blasco Ibáñez, 15, 46010 Valencia, Spain; (R.S.P.); (R.C.O.d.A.)
| | - David Moratal
- Center for Biomaterials and Tissue Engineering, Universitat Politècnica de València, 46022 Valencia, Spain
- Correspondence: (J.I.P.-Q.); (D.M.)
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Hobusch GM, Platzgummer H. [Evidence in Infiltrative Pain Therapy of the Musculoskeletal System]. ZEITSCHRIFT FUR ORTHOPADIE UND UNFALLCHIRURGIE 2021; 160:229-248. [PMID: 33567456 DOI: 10.1055/a-0968-9792] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Musculoskeletal pain symptoms frequently generate limitations in daily work and life in many patients. Usually, symptomatic treatment is possible before clarifying the in depth diagnosis. A symptom-based infiltration therapy will never replace a thoroughly done physical examination and thoughtful collection of patient history, however, it can be of great benefit for the patient when done focused on the point of pain and executed with profound anatomical knowledge. Furthermore, the knowledge of the level of evidence of therapeutic infiltrations improves their outcomes and shapes realistic patients' expectations. Ultrasound-guided therapeutic infiltrations improve the outcome despite the use of lower amounts of active agents by pinpointed applications. This article provides an overview of the scientific evidence of effectiveness of (ultrasound-guided) infiltration techniques in diverse musculoskeletal regions.
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Abstract
PURPOSE OF REVIEW There has been a recent surge of interest in clinical applications of ultrasound, which has revolutionized acute pain management. This review is to summarize the current status of ultrasound utilization in neuraxial anesthesia, the most common type of regional anesthesia. RECENT FINDINGS Ultrasound-assisted and ultrasound-guided neuraxial anesthesia has improved clinical accuracy and patient safety through landmark identification including proper vertebral level and midline, as well as via measurements on neuraxial space. Direct needle or catheter visualization during the entire procedure has not yet been achieved consistently. The recent introduction of ultrasound into neural anesthesia has clinical performance benefits and patient safety implications, with documented improvement on overall efficacy with higher first attempt success rate as well as less needle pass. More controlled studies are needed for the overall impact of ultrasonography in neuraxial anesthesia in obstetric and non-obstetric patients.
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Affiliation(s)
- Jinlei Li
- Department of Anesthesiology, Yale University, New Haven, CT, USA.
| | - Ramya Krishna
- Department of Anesthesiology, Yale University, New Haven, CT, USA
| | - Yang Zhang
- Department of Anesthesiology and Perioperative Medicine, University of Rochester, Rochester, NY, USA
| | - David Lam
- Department of Anesthesiology, Yale University, New Haven, CT, USA
| | - Nalini Vadivelu
- Department of Anesthesiology, Yale University, New Haven, CT, USA
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Chamlati R, Connolly B, Laxer R, Stimec J, Panwar J, Tse S, Muthusami P, Amaral J, Temple M, Parra DA. Image guided sacroiliac joint corticosteroid injections in children: an 18-year single-center retrospective study. Pediatr Rheumatol Online J 2020; 18:52. [PMID: 32552835 PMCID: PMC7301971 DOI: 10.1186/s12969-020-00435-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2019] [Accepted: 05/06/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Sacroiliitis is commonly seen in enthesitis-related arthritis (ERA), a subtype of juvenile idiopathic arthritis (JIA). Sacroiliitis is characterized by the inflammation of the sacroiliac (SI) joints (+/- adjacent tissues). The treatment options include systemic therapy with or without corticosteroid SI joint injections. Image guided SI joint injections are frequently requested in pediatric patients with sacroiliitis. The purpose of this study was to evaluate the feasibility and efficacy of SI joint injections in children with sacroiliitis. METHODS A retrospective study of patients referred to Interventional Radiology (IR) for SI joint corticosteroid injections (2000-2018). Clinical information was collected from Electronic Patient Charts and procedural details from PACS. Efficacy was determined clinically, by MRI, or both when available. RESULTS 50 patients (13.8 years; M:F = 35:15) underwent image-guided SI joint corticosteroid injections. Most common indications were JIA (84%) and inflammatory bowel disease (14%). 80% had bilateral injections. 80% were performed under general anesthesia and 20% under sedation. The corticosteroid of choice was triamcinolone hexacetonide in 98% of patients. Needle guidance and confirmation was performed using CT and fluoroscopy (54%), Cone Beam CT (CBCT, 46%), with initial ultrasound assistance in 34%. All procedures were technically successful without any complications. 32/50 patients had long-term follow-up (2 years); 21/32 (66%) had clinical improvement within 3-months. Of 15 patients who had both pre- and post-procedure MRIs, 93% showed short-term improvement. At 2 years, 6% of patients were in remission, 44% continued the same treatment and 47% escalated treatment. CONCLUSION Image-guided SI joint injections are safe and technically feasible in children. Imaging modalities for guidance have evolved, with CBCT being the current first choice. Most patients showed short-term clinical and imaging improvement, requiring long-term maintenance or escalation of medical treatment.
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Affiliation(s)
- Racha Chamlati
- grid.17063.330000 0001 2157 2938Division of Image Guided Therapy, Department of Diagnostic Imaging, The Hospital for Sick Children, University of Toronto, 555 University Avenue, Toronto, ON M5G 1X8 Canada
| | - Bairbre Connolly
- grid.17063.330000 0001 2157 2938Division of Image Guided Therapy, Department of Diagnostic Imaging, The Hospital for Sick Children, University of Toronto, 555 University Avenue, Toronto, ON M5G 1X8 Canada
| | - Ronald Laxer
- grid.17063.330000 0001 2157 2938Division of Rheumatology, Department of Paediatrics, The Hospital for Sick Children, University of Toronto, Toronto, Canada
| | - Jennifer Stimec
- grid.17063.330000 0001 2157 2938Department of Diagnostic Imaging, The Hospital for Sick Children, University of Toronto, Toronto, Canada
| | - Jyoti Panwar
- grid.17063.330000 0001 2157 2938Department of Diagnostic Imaging, The Hospital for Sick Children, University of Toronto, Toronto, Canada
| | - Shirley Tse
- grid.17063.330000 0001 2157 2938Division of Rheumatology, Department of Paediatrics, The Hospital for Sick Children, University of Toronto, Toronto, Canada
| | - Prakash Muthusami
- grid.17063.330000 0001 2157 2938Division of Image Guided Therapy, Department of Diagnostic Imaging, The Hospital for Sick Children, University of Toronto, 555 University Avenue, Toronto, ON M5G 1X8 Canada
| | - Joao Amaral
- grid.17063.330000 0001 2157 2938Division of Image Guided Therapy, Department of Diagnostic Imaging, The Hospital for Sick Children, University of Toronto, 555 University Avenue, Toronto, ON M5G 1X8 Canada
| | - Michael Temple
- grid.17063.330000 0001 2157 2938Division of Image Guided Therapy, Department of Diagnostic Imaging, The Hospital for Sick Children, University of Toronto, 555 University Avenue, Toronto, ON M5G 1X8 Canada
| | - Dimitri A. Parra
- grid.17063.330000 0001 2157 2938Division of Image Guided Therapy, Department of Diagnostic Imaging, The Hospital for Sick Children, University of Toronto, 555 University Avenue, Toronto, ON M5G 1X8 Canada
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Soni P, Punj J. Ultrasound-Guided Lumbar Transforaminal Epidural Injection: A Narrative Review. Asian Spine J 2020; 15:261-270. [PMID: 32521947 PMCID: PMC8055462 DOI: 10.31616/asj.2019.0245] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2019] [Accepted: 01/13/2020] [Indexed: 12/16/2022] Open
Abstract
Transforaminal epidural steroid injection is often administered to patients with radiculopathy under fluoroscopic guidance, although it has disadvantages of radiation hazards and requirement of a special area to perform the block. To avoid these disadvantages, ultrasound-guided transforaminal injection (USTFI) has recently been described and is continually developed. This review article describes the indexed articles published on USTFI and ultrasound-guided selective nerve block (SNRB) to evaluate current evidence on best approach to perform the block. Through literature search, eight articles and one case report on USTFI and five articles on ultrasound-guided SNRB were found. Most of the studies have utilized parasagittal orientation of curvilinear probe to perform the block. Nevertheless, with the present literature, it is difficult to come to any conclusion. Further studies with larger sample size and description of dye spread patterns are recommended to come to a more definite conclusion.
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Affiliation(s)
- Preeti Soni
- Department of Anaesthesiology, Pain Medicine & Critical Care, All India Institute of Medical Sciences, New Delhi, India
| | - Jyotsna Punj
- Department of Anaesthesiology, Pain Medicine & Critical Care, All India Institute of Medical Sciences, New Delhi, India
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de Almeida Bastos DC, Everson RG, de Oliveira Santos BF, Habib A, Vega RA, Oro M, Rao G, Li J, Ghia AJ, Bishop AJ, Yeboa DN, Amini B, Rhines LD, Tatsui CE. A comparison of spinal laser interstitial thermotherapy with open surgery for metastatic thoracic epidural spinal cord compression. J Neurosurg Spine 2020; 32:667-675. [PMID: 31899882 DOI: 10.3171/2019.10.spine19998] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2019] [Accepted: 10/11/2019] [Indexed: 11/06/2022]
Abstract
OBJECTIVE The proximity of the spinal cord to compressive metastatic lesions limits radiosurgical dosing. Open surgery is used to create safe margins around the spinal cord prior to spinal stereotactic radiosurgery (SSRS) but carries the risk of potential surgical morbidity and interruption of systemic oncological treatment. Spinal laser interstitial thermotherapy (SLITT) in conjunction with SSRS provides local control with less morbidity and a shorter interval to resume systemic treatment. The authors present a comparison between SLITT and open surgery in patients with metastatic thoracic epidural spinal cord compression to determine the advantages and disadvantages of each method. METHODS This is a matched-group design study comprising patients from a single institution with metastatic thoracic epidural spinal cord compression that was treated either with SLITT or open surgery. The two cohorts defined by the surgical treatment comprised patients with epidural spinal cord compression (ESCC) scores of 1c or higher and were deemed suitable for either treatment. Demographics, pre- and postoperative ESCC scores, histology, morbidity, hospital length of stay (LOS), complications, time to radiotherapy, time to resume systemic therapy, progression-free survival (PFS), and overall survival (OS) were compared between groups. RESULTS Eighty patients were included in this analysis, 40 in each group. Patients were treated between January 2010 and December 2016. There was no significant difference in demographics or clinical characteristics between the cohorts. The SLITT cohort had a smaller postoperative decrease in the extent of ESCC but a lower estimated blood loss (117 vs 1331 ml, p < 0.001), shorter LOS (3.4 vs 9 days, p < 0.001), lower overall complication rate (5% vs 35%, p = 0.003), fewer days until radiotherapy or SSRS (7.8 vs 35.9, p < 0.001), and systemic treatment (24.7 vs 59 days, p = 0.015). PFS and OS were similar between groups (p = 0.510 and p = 0.868, respectively). CONCLUSIONS The authors' results have shown that SLITT plus XRT is not inferior to open decompression surgery plus XRT in regard to local control, with a lower rate of complications and faster resumption of oncological treatment. A prospective randomized controlled study is needed to compare SLITT with open decompressive surgery for ESCC.
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Affiliation(s)
| | - Richard George Everson
- 2Department of Neurosurgery, David Geffen School of Medicine at UCLA, Los Angeles, California
| | | | | | | | | | | | | | | | | | | | - Behrang Amini
- 4Diagnostic Radiology, The University of Texas MD Anderson Cancer Center, Houston, Texas; and
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Oliveira CB, Maher CG, Ferreira ML, Hancock MJ, Oliveira VC, McLachlan AJ, Koes BW, Ferreira PH, Cohen SP, Pinto RZ. Epidural corticosteroid injections for lumbosacral radicular pain. Cochrane Database Syst Rev 2020; 4:CD013577. [PMID: 32271952 PMCID: PMC7145384 DOI: 10.1002/14651858.cd013577] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
BACKGROUND Lumbosacral radicular pain (commonly called sciatica) is a syndrome involving patients who report radiating leg pain. Epidural corticosteroid injections deliver a corticosteroid dose into the epidural space, with the aim of reducing the local inflammatory process and, consequently, relieving the symptoms of lumbosacral radicular pain. This Cochrane Review is an update of a review published in Annals of Internal Medicine in 2012. Some placebo-controlled trials have been published recently, which highlights the importance of updating the previous review. OBJECTIVES To investigate the efficacy and safety of epidural corticosteroid injections compared with placebo injection on pain and disability in patients with lumbosacral radicular pain. SEARCH METHODS We searched the following databases without language limitations up to 25 September 2019: Cochrane Back and Neck group trial register, CENTRAL, MEDLINE, Embase, CINAHL, PsycINFO, International Pharmaceutical Abstracts, and two trial registers. We also performed citation tracking of included studies and relevant systematic reviews in the field. SELECTION CRITERIA We included studies that compared epidural corticosteroid injections of any corticosteroid drug to placebo injections in patients with lumbosacral radicular pain. We accepted all three anatomical approaches (caudal, interlaminar, and transforaminal) to delivering corticosteroids into the epidural space. We considered trials that included a placebo treatment as delivery of an inert substance (i.e. one with no pharmacologic activity), an innocuous substance (e.g. normal saline solution), or a pharmacologically active substance but not one considered to provide sustained benefit (e.g. local anaesthetic), either into the epidural space (i.e. to mimic epidural corticosteroid injection) or adjacent spinal tissue (i.e. subcutaneous, intramuscular, or interspinous tissue). We also included trials in which a local anaesthetic with a short duration of action was used as a placebo and injected together with corticosteroid in the intervention group. DATA COLLECTION AND ANALYSIS Two authors independently performed the screening, data extraction, and 'Risk of bias' assessments. In case of insufficient information, we contacted the authors of the original studies or estimated the data. We grouped the outcome data into four time points of assessment: immediate (≤ 2 weeks), short term (> 2 weeks but ≤ 3 months), intermediate term (> 3 months but < 12 months), and long term (≥ 12 months). We assessed the overall quality of evidence for each outcome and time point using the GRADE approach. MAIN RESULTS We included 25 clinical trials (from 29 publications) investigating the effects of epidural corticosteroid injections compared to placebo in patients with lumbosacral radicular pain. The included studies provided data for a total of 2470 participants with a mean age ranging from 37.3 to 52.8 years. Seventeen studies included participants with lumbosacral radicular pain with a diagnosis based on clinical assessment and 15 studies included participants with mixed duration of symptoms. The included studies were conducted mainly in North America and Europe. Fifteen studies did not report funding sources, five studies reported not receiving funding, and five reported receiving funding from a non-profit or government source. Eight trials reported data on pain intensity, 12 reported data on disability, and eight studies reported data on adverse events. The duration of the follow-up assessments ranged from 12 hours to 1 year. We considered eight trials to be of high quality because we judged them as having low risk of bias in four out of the five bias domains. We identified one ongoing trial in a trial registry. Epidural corticosteroid injections were probably slightly more effective compared to placebo in reducing leg pain at short-term follow-up (mean difference (MD) -4.93, 95% confidence interval (CI) -8.77 to -1.09 on a 0 to 100 scale; 8 trials, n = 949; moderate-quality evidence (downgraded for risk of bias)). For disability, epidural corticosteroid injections were probably slightly more effective compared to placebo in reducing disability at short-term follow-up (MD -4.18, 95% CI -6.04 to -2.17, on a 0 to 100 scale; 12 trials, n = 1367; moderate-quality evidence (downgraded for risk of bias)). The treatment effects are small, however, and may not be considered clinically important by patients and clinicians (i.e. MD lower than 10%). Most trials provided insufficient information on how or when adverse events were assessed (immediate or short-term follow-up) and only reported adverse drug reactions - that is, adverse events that the trialists attributed to the study treatment. We are very uncertain that epidural corticosteroid injections make no difference compared to placebo injection in the frequency of minor adverse events (risk ratio (RR) 1.14, 95% CI 0.91 to 1.42; 8 trials, n = 877; very low quality evidence (downgraded for risk of bias, inconsistency and imprecision)). Minor adverse events included increased pain during or after the injection, non-specific headache, post-dural puncture headache, irregular periods, accidental dural puncture, thoracic pain, non-local rash, sinusitis, vasovagal response, hypotension, nausea, and tinnitus. One study reported a major drug reaction for one patient on anticoagulant therapy who had a retroperitoneal haematoma as a complication of the corticosteroid injection. AUTHORS' CONCLUSIONS This study found that epidural corticosteroid injections probably slightly reduced leg pain and disability at short-term follow-up in people with lumbosacral radicular pain. In addition, no minor or major adverse events were reported at short-term follow-up after epidural corticosteroid injections or placebo injection. Although the current review identified additional clinical trials, the available evidence still provides only limited support for the use of epidural corticosteroid injections in people with lumbosacral radicular pain as the treatment effects are small, mainly evident at short-term follow-up and may not be considered clinically important by patients and clinicians (i.e. mean difference lower than 10%). According to GRADE, the quality of the evidence ranged from very low to moderate, suggesting that further studies are likely to play an important role in clarifying the efficacy and tolerability of this treatment. We recommend that further trials should attend to methodological features such as appropriate allocation concealment and blinding of care providers to minimise the potential for biased estimates of treatment and harmful effects.
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Affiliation(s)
- Crystian B Oliveira
- São Paulo State UniversityDepartment of PhysiotherapyRua Roberto Simonsen, 305Presidente PrudenteSão PauloBrazilCEP 19060‐900
| | - Christopher G Maher
- University of SydneySydney School of Public HealthLevel 10 North, King George V Building, Missenden Road, CamperdownSydneyNSWAustralia2050
| | - Manuela L Ferreira
- Sydney Medical School, The University of SydneyInstitute of Bone and Joint Research, The Kolling InstituteSydneyNSWAustralia
| | - Mark J Hancock
- Macquarie UniversityDiscipline of Physiotherapy, Faculty of Medicine and Health SciencesSydneyAustralia
| | - Vinicius Cunha Oliveira
- Universidade Federal dos Vales do Jequitinhonha e Mucuri (UFVJM)Departamento de FisioterapiaCampus JK ‐ Rodovia MGT 367‐ Km 583, nº 5000 ‐ Alto da JacubaDiamantinaMinas GeraisBrazil39100‐000
| | - Andrew J McLachlan
- University of SydneyFaculty of PharmacyA15 ‐ PharmacyRoom N405SydneyNSWAustralia2006
| | - Bart W Koes
- University of Southern DenmarkCenter for Muscle and HealthOdenseDenmark
| | - Paulo H Ferreira
- The University of SydneyDiscipline of Physiotherapy, Faculty of Health Sciences75 East StreetSydneyLidcombe NSWAustralia1825
| | - Steven P Cohen
- Johns Hopkins University School of MedicineBlaustein Pain Treatment Center, Department of AnesthesiologyBaltimoreMarylandUSA
| | - Rafael Zambelli Pinto
- Universidade Federal de Minas Gerais (UFMG)Department of PhysiotherapyAv. Pres. Antônio Carlos, 6627Belo Horizonte ‐ MGBelo Horizonte, Minas GeraisMinas Gerais(MG)BrazilCEP 31270‐901
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Use of fluoroscopic-guided transsacral block for the treatment of iatrogenic post-injection sciatic neuropathy: Report of three cases. Turk J Phys Med Rehabil 2020; 65:406-410. [PMID: 31893279 DOI: 10.5606/tftrd.2019.3077] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2018] [Accepted: 08/31/2018] [Indexed: 11/21/2022] Open
Abstract
Post-injection sciatic neuropathy (PISN) from an inadvertent intramuscular injection in the gluteal region is a type of iatrogenic sciatic nerve injury. Patients with neuropathic pain following PISN frequently experience disability leading to restrictions in daily activities and pain, which may be resistant to conventional treatments and physiotherapy in some cases. To date, minimal invasive procedures for neuropathic pain have been performed with various medications at the site of lesion. Herein, we report three adult male cases with PISN-associated neu- ropathic pain who were resistant to conservative management and were treated with fluoroscopy-guided transsacral block.
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Intra-articular facet joint steroid injection–related adverse events encountered during 11,980 procedures. Eur Radiol 2019; 30:1507-1516. [DOI: 10.1007/s00330-019-06483-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2019] [Accepted: 10/09/2019] [Indexed: 02/07/2023]
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Hashemi M, Dadkhah P, Taheri M, Haji Seyed Abootorabi SM, Naderi-Nabi B. Ultrasound-Guided Lumbar Transforaminal Epidural Injections; A Single Center Fluoroscopic Validation Study. Bull Emerg Trauma 2019; 7:251-255. [PMID: 31392224 DOI: 10.29252/beat-070307] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022] Open
Abstract
Objective To investigate the success rate (technical precision) of ultrasound-guided lumbar transforaminal epidural steroid injection, which was validated by conventional fluoroscopic technique. Methods A total of 20 patients with unilateral single-level lumbar foraminal disc protrusion causing radiculopathy were enrolled. Using transforming route, the needle location was determined by an axial (transvers) view of the ultrasound with fluoroscopic confirmation. We determined the needle placement accuracy of ultrasound- guided lumbar transforaminal injections approach. Results The accuracy of ultrasound-guided interventions was 90% as confirmed by fluoroscopy. There were 2 failed cases at the L4-L5 level in the US-guided. The success rate in L5-S1 level was 100%, in L4-L5 level was 80% and in L3-L4 level was 100%. No complications were noted. Conclusion Ultrasound-guided lumbar transforaminal epidural injections are accurate and feasible in clinical setting with an accuracy of 90% and no complications.
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Affiliation(s)
- Masoud Hashemi
- Anesthesiology Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Payman Dadkhah
- Anesthesiology Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mehrdad Taheri
- Anesthesiology Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | | | - Bahram Naderi-Nabi
- Department of Anesthesiology and Pain, Guilan University of Medical Sciences, Rasht, Guilan, Iran
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Ryu JH, Lee CS, Kim YC, Lee SC, Shankar H, Moon JY. Ultrasound-Assisted Versus Fluoroscopic-Guided Lumbar Sympathetic Ganglion Block: A Prospective and Randomized Study. Anesth Analg 2019; 126:1362-1368. [PMID: 29189275 DOI: 10.1213/ane.0000000000002640] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
BACKGROUND Fluoroscopy (FL)-guided lumbar sympathetic ganglion block (LSGB) is widely performed to diagnose and manage various diseases associated with sympathetically maintained pain. Recently, numerous ultrasound (US)-assisted procedures in pain medicine have been attempted, showing an advantage of low radiation exposure. This randomized, prospective trial compared the procedural outcomes and complications between FL-guided and US-assisted LSGBs. METHODS Fifty LSGBs were randomly divided into 2 groups: FL-guided (FL group) or US-assisted (US group) LSGB group. Both groups received FL-guided or US-assisted LSGB with 10 mL of 0.25% levobupivacaine. The primary end point was the total procedure time. Secondary outcomes were success rate, imaging time, onset time (based on temperature rise), dosage of radiation exposure, other procedure-related outcomes, and complications. RESULTS Total procedure time and success rate were not statistically different between the 2 groups, whereas imaging time of the US group was longer than that of the FL group (P = .012). The onset time was faster in the US group (P = .019), and bone touching during the procedure was less frequent in the US group (P = .001). Moreover, radiation exposure was significantly lower in the US group than in the FL group (P < .001). No serious complications were reported in all patients. CONCLUSIONS US-assisted LSGB appears to be a feasible method with the added benefit of lower radiation exposure. In our study, we did not find an advantage of US-assisted LSGB over FL-guided LSGB in terms of performance time.
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Affiliation(s)
| | - Chang Soon Lee
- Department of Anesthesiology and Pain Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Yong-Chul Kim
- Department of Anesthesiology and Pain Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Sang Chul Lee
- Department of Anesthesiology and Pain Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Hariharan Shankar
- Department of Anesthesiology, Clement Zablocki VA Medical Center, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Jee Youn Moon
- Department of Anesthesiology and Pain Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Republic of Korea.,Department of Integrated Cancer Care Center, Seoul National University Cancer Hospital, Seoul, Republic of Korea
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Evansa I, Krumina A, Simonova A, Dzabijeva V, Fedorovica S, Hadunkina A, Zlobina N, Vabels G, Strike E, Viksna L, Vanags I. Ultrasound-Assisted Lumbar Interlaminar Epidural Dye Injection and Evaluation of Its Distribution by Anatomical Dissection. Front Med (Lausanne) 2019; 6:49. [PMID: 30915336 PMCID: PMC6422940 DOI: 10.3389/fmed.2019.00049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2018] [Accepted: 02/21/2019] [Indexed: 11/13/2022] Open
Abstract
Background: Epidural steroid injections are frequently used to treat lumbar radicular pain. However, the spread of a solute in the epidural space needs further elucidation. We aimed at assessing the distribution of green dye in the epidural space after lumbar epidural injection on cadavers. Methods: We performed ultrasound-guided injections of green dye between lumbar vertebrae 4 and 5 in 24 cadavers. The cadavers were randomly divided into group A and B according to the volume of injected dye; 3 ml in group A (n = 13) and 6 ml in group B (n = 11). Accuracy of the needle insertion and patterns and distributions of the spread were compared between the groups. After local dissection, we examined the spread of dye in dorsal and ventral epidural spaces and presented the distribution as whole numbers and quartiles of intervertebral segments. Mann-Whitney U Test was used to compare distribution of dye spread between groups A and B. Wilcoxon Signed-Rank Test was used to compare the spread of dye in cranial and caudal direction within the group. We considered P < 0.05 as significant. Results: Data were obtained from all 24 cadavers. Median levels of dorsal cranial dye distribution in groups A and B were 2 and 4 (P = 0.02), respectively. In the dorsal caudal−2 and 2, respectively (P = 0.04). In the ventral epidural space cranial dye spread medians were−0 and 2 in groups, respectively (P = 0.04). Ventral caudal spread was 0 and 1, respectively (P = 0.03). We found a significant difference between cranial and caudal dye distribution in group B (P < 0.05). In group A the dye spread was bilateral. In group B cranial and caudal dye spread was observed. Conclusions: Ventral dye flow was observed in 50% of injections. Bilateral spread of dye occurred in 63%, and more often in group A. Cranial spread was slightly higher than caudal spread in group A despite a smaller injected volume, and significantly higher in group B following a larger volume.
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Affiliation(s)
- Irina Evansa
- Department of Anesthesiology and Pain Medicine, Riga 1st Hospital, Riga, Latvia
- Department of Anesthesiology and Intensive Care, Medical Faculty, Riga Stradins University, Riga, Latvia
- *Correspondence: Irina Evansa
| | - Angelika Krumina
- Department of Infectology and Dermatology, Medical Faculty, Riga Stradins University, Riga, Latvia
| | - Anna Simonova
- Department of Anesthesiology and Pain Medicine, Riga 1st Hospital, Riga, Latvia
| | - Viktorija Dzabijeva
- Department of Anesthesiology and Pain Medicine, Riga 1st Hospital, Riga, Latvia
| | - Svetlana Fedorovica
- Department of Anesthesiology and Pain Medicine, Riga 1st Hospital, Riga, Latvia
| | - Alla Hadunkina
- Department of Anesthesiology and Pain Medicine, Riga 1st Hospital, Riga, Latvia
- Department of Anesthesiology and Intensive Care, Medical Faculty, Riga Stradins University, Riga, Latvia
| | - Natalja Zlobina
- Department of Anesthesiology and Pain Medicine, Riga 1st Hospital, Riga, Latvia
| | | | - Eva Strike
- Department of Anesthesiology and Intensive Care, Medical Faculty, Riga Stradins University, Riga, Latvia
| | - Ludmila Viksna
- Department of Infectology and Dermatology, Medical Faculty, Riga Stradins University, Riga, Latvia
| | - Indulis Vanags
- Department of Anesthesiology and Intensive Care, Medical Faculty, Riga Stradins University, Riga, Latvia
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The preliminary results of a new CT-guided periradicular cervical steroid injection technique: safety and feasibility of the lateral peri-isthmic approach in 28 patients. Skeletal Radiol 2018; 47:1607-1613. [PMID: 29882012 DOI: 10.1007/s00256-018-2986-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2018] [Revised: 04/15/2018] [Accepted: 05/23/2018] [Indexed: 02/02/2023]
Abstract
BACKGROUND Computed tomography (CT)-guided cervical nerve injections are broadly being used in the treatment of cervical radiculopathy; however, catastrophic complications have been reported. Herein, we aimed to evaluate the efficacy, feasibility, and safety of a novel CT-guided cervical injection technique. MATERIALS AND METHODS We prospectively performed cervical injections in 28 patients with cervical radiculopathies using a novel CT-guided cervical transforaminal injection technique; lateral peri-isthmic approach in which the tip of the needle advanced to the lateral cortex of the isthmus instead of the foraminal area. Patients' pain reduction rates were evaluated using visual analog scores (VAS) at pre-treatment, immediately after treatment, at 3 weeks and 6 months after the treatment. Intra-vascular contrast medium injections and distribution of the contrast material into the foraminal, epidural or extraforaminal area during the procedure were noted. RESULTS Pre-treatment pain scores were reduced by 4.2 ± 1.4 (p < 0.001), 3.9 ± 1.37 (p < 0.001) and 3.25 ± 1.53 (p < 0.001) immediately after the treatment, 3 weeks and 6 months after the treatment respectively. The number of patients with >50% pain relief as measured by VAS were 21 (75%) immediately after the procedure, 19 (67.8%) at 3 weeks and 17 (60%) at 6 months after the procedure. The injected contrast material was dispersed into the neural foramen in 9 cases (32.1%), the foraminal and epidural area in 14 cases (50%) and the extraforaminal area in 5 cases (17.9%). CONCLUSION The CT-guided lateral peri-isthmic approach seems to be a secure and feasible method for cervical injections with satisfactory pain reduction.
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Real-time fusion-imaging in low back pain: a new navigation system for facet joint injections. Radiol Med 2018; 123:851-859. [PMID: 29968070 DOI: 10.1007/s11547-018-0916-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2018] [Accepted: 06/25/2018] [Indexed: 02/07/2023]
Abstract
AIMS AND OBJECTIVES The aim of the current study is to present our experience in lumbar spine interventional procedures performed with a newly developed multimodal echo-navigator (EcoNav) and to evaluate short-term clinical outcomes of a series of patients affected by facet joint disease (FJD) treated with steroid and anaesthetic injection under fusion-imaging guidance, compared to a cohort of patients that received the same treatment under computed tomography (CT) guidance. METHODS Sixty-five consecutive patients (34 females; mean age 68.3 ± 12.8 years) with a clinical diagnosis of non-radicular low back pain lasting for more than 6-weeks and magnetic resonance (MR) or CT confirmed FJD were enrolled for image-guided FJI. Twenty-eight patients underwent FJI with fusion-guided technique, while CT-guided procedures were performed in the other cases. Clinical and procedural data were recorded and compared at a mean follow-up of 6.1 ± 2.0 months. RESULTS A significant improvement in clinical parameters was observed for both fusion-guided and CT-guided group. Comparing both groups, no statistically significant difference could be detected neither at baseline conditions nor during the follow-up period. No significant periprocedural complication occurred in both groups. A satisfaction rate of 92.3 and 81.1% was reported for fusion-guided and CT-guided group, respectively. CONCLUSION EcoNav fusion-imaging system represents a safe, feasible, effective and reproducible guidance option in FJD infiltration procedures, also avoiding use of ionising radiations.
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Hoffman MD, Agnish V. Functional outcome from sacroiliac joint prolotherapy in patients with sacroiliac joint instability. Complement Ther Med 2018; 37:64-68. [PMID: 29609940 DOI: 10.1016/j.ctim.2018.01.014] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2017] [Revised: 01/24/2018] [Accepted: 01/24/2018] [Indexed: 10/18/2022] Open
Abstract
OBJECTIVES Examine the effectiveness of sacroiliac (SI) joint prolotherapy for SI joint instability, and characterize the patients most likely to benefit from this treatment. DESIGN Retrospective cohort study. SETTING Department of Veterans Affairs outpatient physical medicine clinic. INTERVENTIONS Patients referred for low back pain and diagnosed with SI joint instability received a series of three SI joint prolotherapy injections (15% dextrose in lidocaine) at approximately a one-month interval. The outcome of those completing treatment was retrospectively examined, and characteristics were compared between those with at least a minimum clinically important improvement and those without improvement. MAIN OUTCOME MEASURES Patients completed the Oswestry Disability Index (ODI) before treatment was initiated, immediately preceding each prolotherapy injection, and at 3-4 month follow-up. RESULTS Of 103 treated patients returning for post-treatment follow-up at a median of 117 days, 24 (23%) showed a minimum clinically important improvement despite a median of 2 years with low back pain and a mean (±SD) pre-intervention ODI of 54 ± 15 points. Much of the improvement was evident after the initial prolotherapy injection, and a 15-point improvement in ODI prior to the second prolotherapy injection had a sensitivity of 92% and specificity of 80% for determining which patients would improve. CONCLUSIONS A satisfactory proportion of patients with symptomatic SI joint instability as an etiology of low back pain can have clinically meaningful functional gains with prolotherapy treatment. The patients who are not likely to improve with prolotherapy are generally evident by lack of improvement following the initial prolotherapy injection.
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Affiliation(s)
- Martin D Hoffman
- Physical Medicine & Rehabilitation Service, Department of Veterans Affairs, Northern California Health Care System, Sacramento, CA, United States; Department of Physical Medicine & Rehabilitation, University of California Davis Medical Center, Sacramento, CA, United States; Ultra Sports Science Foundation, United States.
| | - Vikram Agnish
- Physical Medicine & Rehabilitation Service, Department of Veterans Affairs, Northern California Health Care System, Sacramento, CA, United States
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Do Superior or Inferior Interlaminar Approach or Bevel Orientation Predispose to Nonepidural Needle Penetration? AJR Am J Roentgenol 2017; 209:895-903. [PMID: 28796547 DOI: 10.2214/ajr.17.18111] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
OBJECTIVE There is a paucity of evidence-based literature regarding the advantages and disadvantages of the interlaminar approach and needle bevel orientation for performing a lumbar interlaminar epidural steroid injection (ESI). The purpose of this study was to determine if superior versus inferior lamina approach, needle bevel tip orientation, or both may predispose to inadvertent nonepidural penetration during lumbar interlaminar ESI. SUBJECTS AND METHODS A prospective study was performed of patients with low back pain with or without radicular pain or neurogenic claudication referred for lumbar interlaminar ESI. Two hundred eleven patients were randomized by interlaminar approach (superior vs inferior) and bevel tip orientation (cranial vs caudal). Lumbar interlaminar ESI was performed by six interventionalists of varying levels of experience using fluoroscopic guidance with curved tip epidural needles, using loss-of-resistance technique and confirmation with contrast opacification. Exact Poisson regression was used to model the study outcome. RESULTS Two hundred twenty-one lumbar interlaminar ESIs were performed on 211 patients, randomized to a superior (n = 121) or inferior lamina approach (n = 100) and to a cranial (n = 103) or caudal (n = 118) orientation of the bevel tip. Epidural needle placement was confirmed in 96.4% (n = 213) of cases. Nonepidural needle placement was most commonly associated with superior lamina approach and caudal bevel tip orientation, which was marginally significant (adjusted risk ratio, 6.88; 95% CI, 0.93-∞; p = 0.059). CONCLUSION Inadvertent nonepidural needle penetration during fluoroscopically guided lumbar interlaminar ESI appears to be affected by approach, with superior lamina approach and caudal bevel tip orientation being the least favorable technique.
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Epidural steroid injection-related events requiring hospitalisation or emergency room visits among 52,935 procedures performed at a single centre. Eur Radiol 2017; 28:418-427. [DOI: 10.1007/s00330-017-4977-7] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2017] [Revised: 06/21/2017] [Accepted: 06/29/2017] [Indexed: 12/22/2022]
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The Lumbar Neural Foramen and Transforaminal Epidural Steroid Injections: An Anatomic Review With Key Safety Considerations in Planning the Percutaneous Approach. AJR Am J Roentgenol 2017; 209:W26-W35. [DOI: 10.2214/ajr.16.17471] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
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Dias TR, Alves Junior JDDDC, Abdala N. Learning curve of radiology residents during training in fluoroscopy-guided facet joint injections. Radiol Bras 2017; 50:162-169. [PMID: 28670027 PMCID: PMC5487230 DOI: 10.1590/0100-3984.2015.0176] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
OBJECTIVE To develop a simulator for training in fluoroscopy-guided facet joint injections and to evaluate the learning curve for this procedure among radiology residents. MATERIALS AND METHODS Using a human lumbar spine as a model, we manufactured five lumbar vertebrae made of methacrylate and plaster. These vertebrae were assembled in order to create an anatomical model of the lumbar spine. We used a silicon casing to simulate the paravertebral muscles. The model was placed into the trunk of a plastic mannequin. From a group of radiology residents, we recruited 12 volunteers. During simulation-based training sessions, each student carried out 16 lumbar facet injections. We used three parameters to assess the learning curves: procedure time; fluoroscopy time; and quality of the procedure, as defined by the positioning of the needle. RESULTS During the training, the learning curves of all the students showed improvement in terms of the procedure and fluoroscopy times. The quality of the procedure parameter also showed improvement, as evidenced by a decrease in the number of inappropriate injections. CONCLUSION We present a simple, inexpensive simulation model for training in facet joint injections. The learning curves of our trainees using the simulator showed improvement in all of the parameters assessed.
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Affiliation(s)
- Tiago Rocha Dias
- MD, Radiologist, Research Student in Radiology, Department of Diagnostic Imaging, Escola Paulista de Medicina da Universidade Federal de São Paulo (EPM-Unifesp), São Paulo, SP, Brazil
| | - João de Deus da Costa Alves Junior
- MD, Interventional Neuroradiologist, Research Student in Radiology, Department of Diagnostic Imaging, Escola Paulista de Medicina da Universidade Federal de São Paulo (EPM-Unifesp), São Paulo, SP, Brazil
| | - Nitamar Abdala
- Full Professor of Radiology, Head of the Department of Diagnostic Imaging, Escola Paulista de Medicina da Universidade Federal de São Paulo (EPM-Unifesp), São Paulo, SP, Brazil
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Sartoris R, Orlandi D, Corazza A, Sconfienza LM, Arcidiacono A, Bernardi SP, Schiaffino S, Turtulici G, Caruso P, Silvestri E. In vivo feasibility of real-time MR-US fusion imaging lumbar facet joint injections. J Ultrasound 2017; 20:23-31. [PMID: 28298941 DOI: 10.1007/s40477-016-0233-2] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2016] [Accepted: 12/07/2016] [Indexed: 12/29/2022] Open
Abstract
OBJECTIVES Traditionally, facet joint injections (FJI) are performed under fluoroscopic or computed tomography (CT) guidance, mainly due to the deep anatomical location and the presence of bony landmarks. Fusion imaging technology, which couples the ultrasound scan with the corresponding CT or magnetic resonance (MR) image obtained from the diagnostic examination and reformatted in real time according to the ultrasound scanning plane, allows to combine the panoramic view and the elevated anatomical detail of MR or CT with the ease of use of ultrasound without patient exposure to ionizing radiation. METHODS Thirty eight patients (24 females; mean age ± SD: 64 ± 9 years) received MR fusion-assisted ultrasound-guided FJI of 1 ml of a mixture of local anaesthetic and corticosteroid using a ultrasound machine (Logiq E9, GE Healthcare) equipped with a GPS-enhanced fusion imaging technology which couples real-time B-mode images with those of the previous recent diagnostic MR examination. Low-dose CT needle positioning confirmation was performed in the first 28 patients. Patients' pain was recorded using a visual analogue scale (VAS), at baseline and at 2, 4 and 8 weeks. RESULTS All fusion imaging-guided injections were performed successfully. Out of 112, 96 FJI had optimal intra-articular needle positioning (accuracy: 85.7%). Patients VAS significantly decreases after the procedure with no differences among who received CT needle positioning control and who did not receive it. No major complications were observed. CONCLUSIONS Ultrasound needle guidance with MR fusion assistance allows for safe and effective injection of degenerative facet joint disease.
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Affiliation(s)
- Riccardo Sartoris
- Scuola di Specializzazione in Radiodiagnostica, Università degli studi di Genova, Genoa, Italy
| | - Davide Orlandi
- S.C. Diagnostica per Immagini, Radiologia, Ospedale Evangelico Internazionale, Corso Solferino 2A, 16100 Genoa, Italy
| | - Angelo Corazza
- Unità Operativa di Radiologia Diagnostica ed Interventistica, IRCCS Istituto Ortopedico Galeazzi, Milan, Italy
- Scuola di dottorato in Neuroscienze, Università degli Studi di Genova, Genoa, Italy
| | - Luca Maria Sconfienza
- Unità Operativa di Radiologia Diagnostica ed Interventistica, IRCCS Istituto Ortopedico Galeazzi, Milan, Italy
- Dipartimento di Scienze Biomediche per la Salute, Università degli Studi di Milano, Milano, Italy
| | - Alice Arcidiacono
- Scuola di Specializzazione in Radiodiagnostica, Università degli studi di Genova, Genoa, Italy
| | - Silvia Perugin Bernardi
- Scuola di Specializzazione in Radiodiagnostica, Università degli studi di Genova, Genoa, Italy
| | - Simone Schiaffino
- Scuola di Specializzazione in Radiodiagnostica, Università degli studi di Genova, Genoa, Italy
| | - Giovanni Turtulici
- S.C. Diagnostica per Immagini, Radiologia, Ospedale Evangelico Internazionale, Corso Solferino 2A, 16100 Genoa, Italy
| | - Pietro Caruso
- S.C. Diagnostica per Immagini, Radiologia, Ospedale Evangelico Internazionale, Corso Solferino 2A, 16100 Genoa, Italy
| | - Enzo Silvestri
- S.C. Diagnostica per Immagini, Radiologia, Ospedale Evangelico Internazionale, Corso Solferino 2A, 16100 Genoa, Italy
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Ultrasound-guided Versus Fluoroscopy-controlled Lumbar Transforaminal Epidural Injections: A Prospective Randomized Clinical Trial. Clin J Pain 2016; 32:103-8. [PMID: 25803759 DOI: 10.1097/ajp.0000000000000237] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
OBJECTIVES Recently, most lumbar spine injections have been administered under ultrasound (US) guidance; however, there is no standard method for US-guided lumbar transforaminal epidural injection (TFEI). In this study, we evaluated the accuracy, effect on pain relief, and safety of US-guided lumbar TFEI. METHODS A total of 80 patients with low back pain and radicular pain were enrolled. The patients were randomly assigned to either the fluoroscopy (FL) group or the US group. The FL-guided approaches were performed under standardized procedures using the C-arm, whereas the US-guided injections were performed with an US device with a linear probe, and were verified by FL. The needle tip reached the lateral side of the lamina in the axis view and the middle of the adjacent facet joints in the parasagittal view. Afterward, the needle was advanced slightly deeper until the loss-of-resistance test was positive. RESULTS The success ratio of the US-guided interventions was 85%. The operation time in the US group (518±103 s) was shorter than the FL group (929±228 s) (P<0.05). In addition, the radiation dosage in the US group (2640±906 μGy m²) was lower than in the FL group (8992±2132 μGy m²). There was no significant difference in pain relief between the US and FL groups. No serious complication was observed in any of the patients in either group. DISCUSSION Lumbar TFEI under US guidance was feasible, safe, and required less radiation to achieve the same benefit as the FL-guided interventions.
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Liotta AP, Girod M, Peeters D, Sandersen C, Couvreur T, Bolen G. Clinical effects of computed tomography–guided lumbosacral facet joint, transforaminal epidural, and translaminar epidural injections of methylprednisolone acetate in healthy dogs. Am J Vet Res 2016; 77:1132-9. [DOI: 10.2460/ajvr.77.10.1132] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Brown JD, Saeed M, Do L, Braz J, Basbaum AI, Iadarola MJ, Wilson DM, Dillon WP. CT-guided injection of a TRPV1 agonist around dorsal root ganglia decreases pain transmission in swine. Sci Transl Med 2016; 7:305ra145. [PMID: 26378245 DOI: 10.1126/scitranslmed.aac6589] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
One approach to analgesia is to block pain at the site of origin or along the peripheral pathway by selectively ablating pain-transmitting neurons or nerve terminals directly. The heat/capsaicin receptor (TRPV1) expressed by nociceptive neurons is a compelling target for selective interventional analgesia because it leaves somatosensory and proprioceptive neurons intact. Resiniferatoxin (RTX), like capsaicin, is a TRPV1 agonist but has greater potency. We combine RTX-mediated inactivation with the precision of computed tomography (CT)-guided delivery to ablate peripheral pain fibers in swine. Under CT guidance, RTX was delivered unilaterally around the lumbar dorsal root ganglia (DRG), and vehicle only was administered to the contralateral side. During a 4-week observation period, animals demonstrated delayed or absent withdrawal responses to infrared laser heat stimuli delivered to sensory dermatomes corresponding to DRG receiving RTX treatment. Motor function was unimpaired as assessed by disability scoring and gait analysis. In treated DRG, TRPV1 mRNA expression was reduced, as were nociceptive neuronal perikarya in ganglia and their nerve terminals in the ipsilateral dorsal horn. CT guidance to precisely deliver RTX to sites of peripheral pain transmission in swine may be an approach that could be tailored to block an array of clinical pain conditions in patients.
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Affiliation(s)
- Jacob D Brown
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, San Francisco, CA 94117, USA
| | - Maythem Saeed
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, San Francisco, CA 94117, USA
| | - Loi Do
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, San Francisco, CA 94117, USA
| | - Joao Braz
- Department of Anatomy, University of California, San Francisco, San Francisco, CA 94117, USA
| | - Allan I Basbaum
- Department of Anatomy, University of California, San Francisco, San Francisco, CA 94117, USA
| | - Michael J Iadarola
- Department of Perioperative Medicine, Clinical Center, National Institutes of Health, Bethesda, MD 20892, USA
| | - David M Wilson
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, San Francisco, CA 94117, USA
| | - William P Dillon
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, San Francisco, CA 94117, USA.
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Sellin JN, Vedantam A, Luerssen TG, Jea A. Safety of epidural triamcinolone acetonide use during lumbar decompression surgery in pediatric patients: an association with delayed pseudomeningocele formation. J Neurosurg Pediatr 2016; 17:667-71. [PMID: 26919317 DOI: 10.3171/2015.12.peds15611] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE The complication profile of epidural triamcinolone acetonide use during lumbar decompression surgery is not known. However, isolated reports of increased risk of delayed CSF leakage with the use of triamcinolone acetonide in adult spinal surgery patients have been published. The purpose of this study was to determine the safety of epidural triamcinolone acetonide use in conjunction with lumbar decompression surgery in pediatric patients. METHODS The medical records of all patients who underwent lumbar decompression surgery with or without discectomy between July 1, 2007, and July 31, 2015, were retrospectively reviewed. RESULTS During the study period, 58 patients underwent 59 spine procedures at Texas Children's Hospital. There were 33 female and 25 male patients. The mean age at surgery was 16.5 years (range 12-24 years). Patients were followed for an average of 38.2 months (range 4-97 months). Triamcinolone acetonide was used in 28 (of 35 total) cases of discectomy; there were no cases of delayed symptomatic CSF leaks (0%) in the minimally invasive and open discectomies. On the other hand, triamcinolone acetonide was used in 14 (of 24 total) cases of multilevel laminectomy, among which there were 10 delayed CSF leaks (71.4%) requiring treatment. The use of triamcinolone acetonide in patients who underwent multilevel laminectomy was significantly associated with an increased risk of delayed CSF leaks or pseudomeningoceles (Fisher's exact test, p < 0.001). CONCLUSIONS There was an unacceptable incidence of delayed postoperative CSF leaks when epidural triamcinolone acetonide was used in patients who underwent multilevel laminectomy.
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Affiliation(s)
- Jonathan N Sellin
- Division of Pediatric Neurosurgery, Texas Children's Hospital, Department of Neurosurgery, Baylor College of Medicine, Houston, Texas
| | - Aditya Vedantam
- Division of Pediatric Neurosurgery, Texas Children's Hospital, Department of Neurosurgery, Baylor College of Medicine, Houston, Texas
| | - Thomas G Luerssen
- Division of Pediatric Neurosurgery, Texas Children's Hospital, Department of Neurosurgery, Baylor College of Medicine, Houston, Texas
| | - Andrew Jea
- Division of Pediatric Neurosurgery, Texas Children's Hospital, Department of Neurosurgery, Baylor College of Medicine, Houston, Texas
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Freire V, Grabs D, Lepage-Saucier M, Moser TP. Ultrasound-Guided Cervical Facet Joint Injections: A Viable Substitution for Fluoroscopy-Guided Injections? JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2016; 35:1253-1258. [PMID: 27151905 DOI: 10.7863/ultra.15.07062] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/27/2015] [Accepted: 09/15/2015] [Indexed: 06/05/2023]
Abstract
OBJECTIVES To evaluate the feasibility of ultrasound (US)-guided cervical facet injections and to identify the potential obstacles to routine use of this technique. METHODS After Institutional Review Board approval, 4 cadavers were used in this study. Age, sex, body mass index, and neck circumference were recorded. A total of 40 facet injections were performed from C2-C3 to C6-C7 under US guidance with radiodense colored latex. Visibility of cervical tissues and the needle was graded as complete, partial, or null (no injection was performed in this case). Frontal and lateral radiographs were taken, followed by cadaveric dissection to assess contrast and the latex distribution, which were recorded as intra-articular (success), peri-articular (success), or absent (failure). A 2-tailed Fisher exact test and Pearson χ(2)test were used to evaluate difference between success and failure rates for qualitative variables. RESULTS Seventy-eight percent (31 of 40) of US-guided facet joint injections were successful. No statistically significant differences were found regarding body mass index, neck circumference, needle caliber, operators, and between left and right sides. All failures involved C2-C3 and C6-C7 levels, and this result was statistically significant (Pearson χ(2) = 20.645; P < .001). CONCLUSIONS Although US-guided cervical facet joint injections are feasible, substantial obstacles may prevent their routine use. The main obstacle is to effectively identify and target the correct cervical level in a prone position.
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Affiliation(s)
- Veronique Freire
- Department of Radiology, Centre de Recherche du Centre Hospitalier de l'Université de Montréal, Montréal, Québec, Canada
| | - Detlev Grabs
- Department of Anatomy, Université du Québec à Trois-Rivières, Trois-Rivières, Québec, Canada
| | - Marianne Lepage-Saucier
- Department of Radiology, Centre de Recherche du Centre Hospitalier de l'Université de Montréal, Montréal, Québec, Canada
| | - Thomas P Moser
- Department of Radiology, Centre de Recherche du Centre Hospitalier de l'Université de Montréal, Montréal, Québec, Canada
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Sae-Jung S, Jirarattanaphochai K. Outcomes of lumbar facet syndrome treated with oral diclofenac or methylprednisolone facet injection: a randomized trial. INTERNATIONAL ORTHOPAEDICS 2016; 40:1091-8. [DOI: 10.1007/s00264-016-3154-y] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/22/2015] [Accepted: 03/06/2016] [Indexed: 10/22/2022]
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Behnami D, Seitel A, Rasoulian A, Anas EMA, Lessoway V, Osborn J, Rohling R, Abolmaesumi P. Joint registration of ultrasound, CT and a shape+pose statistical model of the lumbar spine for guiding anesthesia. Int J Comput Assist Radiol Surg 2016; 11:937-45. [DOI: 10.1007/s11548-016-1369-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2016] [Accepted: 02/26/2016] [Indexed: 11/30/2022]
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Role of Imaging in Musculoskeletal Care. CURRENT PHYSICAL MEDICINE AND REHABILITATION REPORTS 2016. [DOI: 10.1007/s40141-016-0106-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Liotta A, Sandersen C, Couvreur T, Bolen G. TECHNIQUE, DIFFICULTY, AND ACCURACY OF COMPUTED TOMOGRAPHY-GUIDED TRANSLAMINAR AND TRANSFORAMINAL LUMBOSACRAL EPIDURAL AND INTRAARTICULAR LUMBAR FACET JOINT INJECTIONS IN DOGS. Vet Radiol Ultrasound 2015; 57:191-8. [DOI: 10.1111/vru.12320] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2015] [Revised: 09/22/2015] [Accepted: 10/07/2015] [Indexed: 11/28/2022] Open
Affiliation(s)
- Annalisa Liotta
- Diagnostic Imaging Section, Department of Small Animals and Equidae Clinic, Faculty of Veterinary Medicine; University of Liège; Liège Belgium
| | - Charlotte Sandersen
- Anesthesia Section, Department of Small Animals and Equidae Clinic, Faculty of Veterinary Medicine; University of Liège; Liège Belgium
| | - Thierry Couvreur
- Department of Medical Imaging; Centre Hospitalier Chrétien; Liège Belgium
| | - Géraldine Bolen
- Diagnostic Imaging Section, Department of Small Animals and Equidae Clinic, Faculty of Veterinary Medicine; University of Liège; Liège Belgium
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Artner J, Klessinger S. [Interventions on facet joints. Techniques of facet joint injection, medial branch block and radiofrequency ablation]. Radiologe 2015; 55:840-6. [PMID: 26334438 DOI: 10.1007/s00117-015-0006-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Fluoroscopy-guided interventions on facet joints have been used for decades for the symptomatic management of pain in spinal disorders. A large number of imaging techniques are used to achieve a precise and safe needle placement in interventional procedures. Pulsed fluoroscopy is one of the most widely used and well-accepted tools for these procedures. This article presents a technical overview of commonly used fluoroscopy-guided interventions on the facet joints of the cervical and lumbar spine, such as facet joint injection, blockade of the medial nerve branches and radiofrequency ablation.
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Affiliation(s)
- J Artner
- Schmerztherapie, Orthopädische Universitätsklinik Ulm am RKU, Oberer Eselsberg 45, 89081, Ulm, Deutschland.
| | - S Klessinger
- Nova Clinic, Biberach, Deutschland
- Neurochirurgische Universitätsklinik Ulm, Ulm, Deutschland
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Ultrasound versus fluoroscopic-guided epidural steroid injections in patients with degenerative spinal diseases. Eur J Anaesthesiol 2015; 32:262-8. [DOI: 10.1097/eja.0000000000000103] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
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Shah RD, Cappiello D, Suresh S. Interventional Procedures for Chronic Pain in Children and Adolescents: A Review of the Current Evidence. Pain Pract 2015; 16:359-69. [DOI: 10.1111/papr.12285] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2014] [Accepted: 12/09/2014] [Indexed: 01/02/2023]
Affiliation(s)
- Ravi D. Shah
- Department of Pediatric Anesthesiology; Ann & Robert H. Lurie Children's Hospital; Northwestern University Feinberg School of Medicine; Chicago Illinois U.S.A
| | - Dario Cappiello
- Department of Anesthesiology; Pain and Intensive Care Medicine; University School of Medicine Campus Bio-Medico of Rome; Rome Italy
| | - Santhanam Suresh
- Department of Pediatric Anesthesiology; Ann & Robert H. Lurie Children's Hospital; Northwestern University Feinberg School of Medicine; Chicago Illinois U.S.A
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CT- and Fluoroscopy-guided Epidural Injection Techniques. Tech Orthop 2014. [DOI: 10.1097/bto.0000000000000103] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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50
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Kim YH, Park HJ, Moon DE. Ultrasound-guided Pararadicular Injection in the Lumbar Spine: A Comparative Study of the Paramedian Sagittal and Paramedian Sagittal Oblique Approaches. Pain Pract 2014; 15:693-700. [DOI: 10.1111/papr.12249] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2014] [Revised: 05/07/2014] [Accepted: 07/13/2014] [Indexed: 11/26/2022]
Affiliation(s)
- Young Hoon Kim
- Department of Anesthesiology and Pain Medicine; College of Medicine; Seoul St. Mary's Hospital; The Catholic University of Korea; Seoul Korea
| | - Hue Jung Park
- Department of Anesthesiology and Pain Medicine; College of Medicine; Seoul St. Mary's Hospital; The Catholic University of Korea; Seoul Korea
| | - Dong Eon Moon
- Department of Anesthesiology and Pain Medicine; College of Medicine; Seoul St. Mary's Hospital; The Catholic University of Korea; Seoul Korea
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