1
|
Taninokuchi Tomassoni M, Braccischi L, Russo M, Adduci F, Calautti D, Girolami M, Vita F, Ruffilli A, Manzetti M, Ponti F, Matcuk GR, Mosconi C, Cirillo L, Miceli M, Spinnato P. Image-Guided Minimally Invasive Treatment Options for Degenerative Lumbar Spine Disease: A Practical Overview of Current Possibilities. Diagnostics (Basel) 2024; 14:1147. [PMID: 38893672 PMCID: PMC11171713 DOI: 10.3390/diagnostics14111147] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2024] [Revised: 05/20/2024] [Accepted: 05/24/2024] [Indexed: 06/21/2024] Open
Abstract
Lumbar back pain is one of the main causes of disability around the world. Most patients will complain of back pain at least once in their lifetime. The degenerative spine is considered the main cause and is extremely common in the elderly population. Consequently, treatment-related costs are a major burden to the healthcare system in developed and undeveloped countries. After the failure of conservative treatments or to avoid daily chronic drug intake, invasive treatments should be suggested. In a world where many patients reject surgery and prefer minimally invasive procedures, interventional radiology is pivotal in pain management and could represent a bridge between medical therapy and surgical treatment. We herein report the different image-guided procedures that can be used to manage degenerative spine-related low back pain. Particularly, we will focus on indications, different techniques, and treatment outcomes reported in the literature. This literature review focuses on the different minimally invasive percutaneous treatments currently available, underlining the central role of radiologists having the capability to use high-end imaging technology for diagnosis and subsequent treatment, allowing a global approach, reducing unnecessary surgeries and prolonged pain-reliever drug intake with their consequent related complications, improving patients' quality of life, and reducing the economic burden.
Collapse
Affiliation(s)
- Makoto Taninokuchi Tomassoni
- Diagnostic and Interventional Radiology, IRCCS Istituto Ortopedico Rizzoli, 40136 Bologna, Italy
- Radiology Department, IRCCS Azienda Ospedaliero-Universitaria Sant’Orsola Malpighi, 40138 Bologna, Italy
| | - Lorenzo Braccischi
- Diagnostic and Interventional Radiology, IRCCS Istituto Ortopedico Rizzoli, 40136 Bologna, Italy
- Radiology Department, IRCCS Azienda Ospedaliero-Universitaria Sant’Orsola Malpighi, 40138 Bologna, Italy
| | - Mattia Russo
- Diagnostic and Interventional Radiology, IRCCS Istituto Ortopedico Rizzoli, 40136 Bologna, Italy
| | - Francesco Adduci
- Neuroradiology, IRCCS Istituto delle Scienze Neurologiche di Bologna, 40139 Bologna, Italy
| | - Davide Calautti
- Neuroradiology, IRCCS Istituto delle Scienze Neurologiche di Bologna, 40139 Bologna, Italy
| | - Marco Girolami
- Spine Surgery Unit, IRCCS Istituto Ortopedico Rizzoli, 40136 Bologna, Italy
| | - Fabio Vita
- 1st Orthopaedic and Traumatologic Clinic, IRCCS Istituto Ortopedico Rizzoli, 40136 Bologna, Italy
| | - Alberto Ruffilli
- 1st Orthopaedic and Traumatologic Clinic, IRCCS Istituto Ortopedico Rizzoli, 40136 Bologna, Italy
| | - Marco Manzetti
- 1st Orthopaedic and Traumatologic Clinic, IRCCS Istituto Ortopedico Rizzoli, 40136 Bologna, Italy
| | - Federico Ponti
- Diagnostic and Interventional Radiology, IRCCS Istituto Ortopedico Rizzoli, 40136 Bologna, Italy
| | - George R. Matcuk
- Department of Imaging, Cedars-Sinai Medical Center, Los Angeles, CA 90048, USA
| | - Cristina Mosconi
- Radiology Department, IRCCS Azienda Ospedaliero-Universitaria Sant’Orsola Malpighi, 40138 Bologna, Italy
| | - Luigi Cirillo
- Neuroradiology, IRCCS Istituto delle Scienze Neurologiche di Bologna, 40139 Bologna, Italy
| | - Marco Miceli
- Diagnostic and Interventional Radiology, IRCCS Istituto Ortopedico Rizzoli, 40136 Bologna, Italy
| | - Paolo Spinnato
- Diagnostic and Interventional Radiology, IRCCS Istituto Ortopedico Rizzoli, 40136 Bologna, Italy
| |
Collapse
|
2
|
Shofwan S, Liem L, Janitra G, Basuki N, Rhatomy S. Discitis Following Radiofrequency Nucleoplasty: A Case Report. Anesth Pain Med 2020; 10:e110322. [PMID: 34150577 PMCID: PMC8207849 DOI: 10.5812/aapm.110322] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2020] [Revised: 11/16/2020] [Accepted: 11/17/2020] [Indexed: 12/16/2022] Open
Abstract
Introduction Radiofrequency nucleoplasty is a minimally invasive procedure to treat chronic low back pain, especially mild degenerative disc diseases. Discitis after radiofrequency nucleoplasty is a rare case. Case Presentation A 62-year-old male patient with a chief complaint of 10 years low back pain, gradually worsening for the last two years, a history of hypertension, chronic kidney disease, and routine dialysis twice a week, referred to the center. He underwent a lumbar medial branch block using radiofrequency and radiofrequency nucleoplasty procedure of lumbar 4-5 (L4-L5). Three weeks after the intervention, he could not move his legs, associated with urinary and fecal incontinence. MRI (magnetic resonance imaging) of the lumbar spine was performed, and the results indicated hyperintensity in L4-L5, suspicious of discitis. Laminectomy at L4 and L5 was performed. Eight months after surgery, the patient could feel and lift legs, and urinary and fecal incontinence was also controlled. Conclusions Early diagnosis of discitis is critical and challenging. Delay in diagnosis may lead to treatment delay and the development of neurological deficits. Comprehensive treatment with bed rest, antimicrobial therapy, and sensible application of timely surgery are essentials to an optimal outcome.
Collapse
Affiliation(s)
- Said Shofwan
- Department of Anesthesiology and Intensive Therapy, Sultan Agung Islamic Hospital, Medical Faculty, Sultan Agung Islamic University, Semarang, Central Java, Indonesia
| | - Liong Liem
- Consultant Pain Management Amsterdam UMC, Universitair Medische Centra (VUmc), Amsterdam, Netherlands
| | - Grady Janitra
- Department of Anesthesiology and Intensive Therapy, Sultan Agung Islamic Hospital, Medical Faculty, Sultan Agung Islamic University, Semarang, Central Java, Indonesia
| | - Nur Basuki
- Department of Anesthesiology and Intensive Therapy, Klaten Islamic Hospital, Klaten, Indonesia
| | - Sholahuddin Rhatomy
- Department of Orthopedics and Traumatology, Dr. Soeradji Tirtonegoro General Hospital, Klaten, Indonesia / Faculty of Medicine, Public Health, and Nursing, Universitas Gadjah Mada, Yogyakarta, Indonesia
- Corresponding Author: Sholahuddin Rhatomy, Department of Orthopedics and Traumatology, Dr. Soeradji Tirtonegoro General Hospital, Klaten, Indonesia / Faculty of Medicine, Public Health, and Nursing, Universitas Gadjah Mada, Yogyakarta, Indonesia.
| |
Collapse
|
3
|
Chen CH, Weng PW, Wu LC, Chiang YF, Chiang CJ. Radiofrequency neurotomy in chronic lumbar and sacroiliac joint pain: A meta-analysis. Medicine (Baltimore) 2019; 98:e16230. [PMID: 31261580 PMCID: PMC6617467 DOI: 10.1097/md.0000000000016230] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Effective treatment of low back pain (LBP) originating in the lumbar and sacroiliac joints is difficult to achieve. The objective of the current study was to compare the clinical effectiveness of radiofrequency (RF) neurotomy versus conservative nonsurgical approaches for the management of chronic lumbar and sacroiliac joint pain. METHODS The PICOS framework was adhered to (P [population]: patients with a history of chronic function-limiting lumbar and sacroiliac joint pain lasting at least 6 months; I [intervention]: RF neurotomy; C [comparator]: other nonsurgical treatments; O [outcomes]: the Oswestry Disability Index (ODI), measurement for pain, and a quality of life (QoL) questionnaire; S [study design]: meta-analysis). Two trained investigators systematically searched Medline, Cochrane, EMBASE, and ISI Web of Knowledge databases for relevant studies published in English through March 2019. RESULTS Patients treated with RF neurotomy (n = 528) had significantly greater improvement in ODI scores, pain scores and QoL measured by EQ-5D compared with controls (n = 457); however, significant heterogeneity was observed when data were pooled from eligible studies. In subgroup analyses, patients who received RF neurotomy had a significantly greater improvement in ODI scores compared with those with sham treatment. Patients treated with RF achieved significantly greater improvement in pain scores compared with controls who received sham treatment or medical treatment. In a subgroup analysis of pain in the sacroiliac joint and in lumbar facet joints, the RF neurotomy group achieved a significantly greater improvement in ODI score and pain scores compared with the control group. The ODI score and pain score were improved after 2 months of follow up in the analyses stratified by follow-up duration. CONCLUSIONS Use of RF neurotomy as an intervention for chronic lumbar and sacroiliac joint pain led to improved function; however, larger, more directly comparable studies are needed to confirm this study's findings.
Collapse
Affiliation(s)
- Chia-Hsien Chen
- Department of Orthopaedics, Shuang Ho Hospital, Taipei Medical University, New Taipei City
- Department of Orthopaedics, School of Medicine, College of Medicine
- School of Biomedical Engineering, College of Biomedical Engineering, Taipei Medical University
| | - Pei-Wei Weng
- Department of Orthopaedics, Shuang Ho Hospital, Taipei Medical University, New Taipei City
- Department of Orthopaedics, School of Medicine, College of Medicine
- School of Biomedical Engineering, College of Biomedical Engineering, Taipei Medical University
| | - Lien-Chen Wu
- Department of Orthopaedics, Shuang Ho Hospital, Taipei Medical University, New Taipei City
- Department of Orthopaedics, School of Medicine, College of Medicine
| | | | - Chang-Jung Chiang
- Department of Orthopaedics, Shuang Ho Hospital, Taipei Medical University, New Taipei City
- Department of Orthopaedics, School of Medicine, College of Medicine
- School of Biomedical Engineering, College of Biomedical Engineering, Taipei Medical University
| |
Collapse
|
4
|
Short-Term Efficacy of Pulsed Radiofrequency Thermal Stimulation on Acupoints for Chronic Low Back Pain: A Preliminary Study of a Randomized, Single-Blinded, Placebo-Controlled Trial. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE 2018; 2018:4510909. [PMID: 30158995 PMCID: PMC6109568 DOI: 10.1155/2018/4510909] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/08/2018] [Accepted: 06/30/2018] [Indexed: 01/31/2023]
Abstract
Background The objective of this study was to evaluate the pain-relief efficacy of thermal stimulation induced by a pulsed radiofrequency (PRF) thermal stimulation applied to acupoints (APs) in patients with low back pain (LBP). The study was designed as a randomized, single-blinded, placebo-controlled trial. Methods. Fifty-six LBP patients whose minimum pain intensity score on a visual analogue scale (VAS, 0-100 mm) was more than 30 mm were randomly allocated to either the placebo-controlled or the treatment group at a 1:1 ratio. The treatment and placebo-controlled groups received PRF thermal stimulation plus cupping therapy and cupping therapy only, respectively. Each patient was scheduled to receive a total of three treatment sessions over one week with allowing a window up to 4 days. Six of the 13 predefined APs were selected differently for each session depending on the change in patient's symptoms and intensity of pain. The primary outcome was the mean difference between the placebo-controlled and treatment group of VAS changes from the baseline to the end of the follow-up period. Results The patients' reported VAS scores from baseline to the end of follow-up (average: 9.8 days) were significantly decreased by 8.036 points (two-sided 95% CI, -11.841 to -4.231) and 13.393 points (two-sided 95% CI: 17.198 to -9.588) in the treatment and the placebo-controlled groups, respectively. However, the change in VAS scores between the treatment group and the placebo-controlled group was not significantly different (2.015 mm, two-sided 95% CI: -5.288 to 9.317). Conclusion The trial results indicated that treatment with either PRF thermal stimulation with cupping therapy or cupping therapy alone effectively relieved LBP. The efficacy of PRF thermal stimulation combined with cupping therapy was not superior to that of cupping therapy alone. Trial registration number: Clinical Research Information Service (KCT0002137). The trial was registered retrospectively on 10 November, 2016.
Collapse
|
5
|
Schianchi PM, Sluijter ME, Balogh SE. The Treatment of Joint Pain with Intra-articular Pulsed Radiofrequency. Anesth Pain Med 2013; 3:250-5. [PMID: 24282777 PMCID: PMC3833041 DOI: 10.5812/aapm.10259] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2013] [Accepted: 02/20/2013] [Indexed: 01/11/2023] Open
Abstract
Background The intra-articular (IA) application of pulsed radiofrequency (PRF) for pain in small and large joints represents a recent development that has proven to be effective in many cases. We performed a retrospective study of 89 such procedures in 57 consecutive patients with chronic articular pain. Objectives The aim of this retrospective study is to evaluate the effectiveness of intraarticular PRF in a group of 57 consecutive patients with chronic joint pain. Patients and Methods Patients with intractable joint pain for more than 6 months were treated with IA PRF 40-45V for 10-15 min in small joints and 60V for 15 min in large joints using fluoroscopic confirmation of correct needle position. A total of 28 shoulders, 40 knees, 10 trapezio-metacarpal, and 11 first metatarso-phalangeal joints were treated. Results were evaluated at 1, 2, and 5 months. The procedure was repeated after 1 month in 10 patients with initial suboptimal results. Success was defined as a reduction of pain score by at least 50%. Results All groups showed significant reductions in pain scores at all three follow-up visits. Success rates were higher in small joints (90% and 82%, respectively) than large ones (64% and 60%, respectively). Interestingly, IA PRF was successful in 6 out of 10 patients who had undergone previous surgery, including 3 with prosthetic joint replacement and in 6 of the 10 repeated procedures. There were no significant adverse effects or complications. Conclusions IA PRF induced significant pain relief of long duration in a majority of our patients with joint pain. The exact mechanism is unclear, but may be related to the exposure of immune cells to low-strength RF fields, inducing an anti-inflammatory effect. The success rate appears to be highest in small joints. We recommend additional research including control groups to further investigate and clarify this method; our data suggest that it may represent a useful modality in the treatment of arthrogenic pain.
Collapse
Affiliation(s)
- Pietro M Schianchi
- S. Anna Clinic, Lugano, Switzerland
- Corresponding author: Pietro M. Schianchi, S. Anna Clinic, Lugano, Switzerland. Tel: +41-919233978, Fax: +41-919238917, E-mail:
| | - Menno E Sluijter
- Centre for Pain Medicine, Swiss Paraplegic Centre, Nottwil, Switzerland
| | - Susan E Balogh
- Centre for Pain Medicine, Swiss Paraplegic Centre, Nottwil, Switzerland
| |
Collapse
|
6
|
Teixeira A, Sluijter ME. Intravenous application of pulsed radiofrequency-4 case reports. Anesth Pain Med 2013; 3:219-22. [PMID: 24223366 PMCID: PMC3821152 DOI: 10.5812/aapm.10242] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2013] [Revised: 02/11/2013] [Accepted: 02/15/2013] [Indexed: 01/24/2023] Open
Abstract
It has been suggested that PRF might possibly have an effect on the immune cells. We considered using the intravenous route to apply PRF in conditions that are caused by an unresolved immune action or connected to allostatic load, implicating an abnormally reacting immune system to obtain a systemic effect that could possibly be an additional tool in treating some of these conditions. These manuscript reports four cases that illustrate the wide variety of conditions where this new technique might be helpful.
Collapse
Affiliation(s)
- Alexandre Teixeira
- Clínica de Dor, Porto, Portugal
- Corresponding author: Alexandre Teixeira, Clínica de Dor, Porto, Portugal. Tel: +351-933300033, Fax: +351-226151367, E-mail:
| | - Menno E. Sluijter
- Centers for Pain Medicine, Swiss Paraplegic Center, Nottwil, Switzerland
| |
Collapse
|