CT引导下选择性神经根注射治疗多节段腰椎间盘突出症的临床研究

目的 探讨CT引导下选择性神经根注射在多节段腰椎间盘突出症中明确责任节段及疗效评估中的作用.方法 33例多节段腰椎间盘突出症患者,在CT引导下对可疑责任节段进行选择性神经根注射治疗,以疼痛视觉模拟评分(VAS)、日本骨科协会(JOA)评分对患者治疗前后的症状进行评估.结果 选择性神经根注射术明确责任节段33例,其中单节段24例(72.7％),2节段9例(27.3％).26例(78.8％)患者术中疼痛症状再现,伴加重,7例(21.2％)患者术中疼痛症状再现,不伴加重.术后VAS评分,20例(60.6％)显著有效,8例(24.2％)中度有效,5例(15.2％)无效,总有效率占84.8％;JOA评分,改善率优8例(24.2％),良12例(36.4％),中5例(15.2％),差8例(24.2％),优良中率占75.8％.结论 CT引导下选择性神经根注射有利于明确复杂的腰椎间盘突出症的责任节段,具有良好的临床疗效,术中患者疼痛症状再现伴加重有利于术后疗效的预判.     

联合注射臭氧(O3)及胶原酶治疗腰椎间盘突出症的临床应用

目的 探讨CT引导下联合注射臭氧（O3）及胶原酶治疗腰椎间盘突出症的临床应用价值。方法在CT引导下对60例腰椎间盘突出症患者，采用盘内注射以及椎体后路突出物内注射臭氧（O3）及胶原酶来治疗腰椎间盘突出症。疗效评价分为3级：显效，有效及无效。结果术后60例患者随访3个月～6个月，显效23例，有效33例，无效4例，总有效率达93％以上。结论CT引导下提高了操作准确性，联合注射臭氧（O3）及胶原酶是治疗腰椎间盘突出症的一种有效、安全的方法。     

经皮穿刺臭氧髓核消融术治疗腰椎间盘突出症的临床研究

目的：探讨臭氧髓核消融术治疗腰椎间盘突出症的临床疗效。方法：112例患者全部在CT引导下经皮穿刺,并在突出间盘内及神经根周围注射臭氧。结果：穿刺成功率为100％。术后随访3～12个月,总有效率（显效和有效）97．32％（109／112）,显效率为82．14％（92／112）,有效率为15．18％（17／112）,无效率为2．68％（3／112）。结论：经皮穿刺臭氧髓核消融术治疗腰椎间盘突出症是一种安全、简捷、有效的方法。     

CT引导下注射臭氧(O3)治疗腰椎间盘突出症

目的 评价CT引导下注射臭氧(O3)治疗腰椎间盘突出症的临床应用价值。方法 在CT引导下对30例腰椎间盘突出症患者，采用盘内注射以及椎体后路突出物内注射臭氧(O3)治疗腰椎间盘突出症。结果 治疗后30例患者经随访1个月至3个月，显效13例，有效15例，无效2例，总有效率达93．3％。结论 CT引导提高了穿刺准确性，严格掌握适应证的情况下，椎间盘内臭氧(O3)注射是治疗腰椎间盘突出症较有效且安全的方法。     

CT引导下神经根周围阻滞配合胶原酶溶核治疗腰椎间盘突出症

目的探讨CT引导下神经根周围阻滞对胶原酶溶核治疗腰椎间盘突出症所致近期疼痛加重的预防效果.材料和方法对21例腰椎间盘突出症的患者采取CT引导下胶原酶溶核治疗的同时加神经根周围阻滞术,观察患者1个月内腰腿痛的变化情况.结果疼痛减轻率76.2%(16/21),14.3%(3/21)无明显变化,9.5%(2/21)出现疼痛加重,加重者经口服止痛药均能忍受疼痛.结论CT引导下神经根周围阻滞能有效预防由胶原酶溶核治疗腰椎间盘突出症所致的近期疼痛加重,操作简便、安全.     

CT引导下经皮穿刺盘内注射臭氧联合神经根阻滞治疗腰椎间盘突出症

目的：探讨CT引导下经皮穿刺椎间盘内注射臭氧联合神经根阻滞治疗腰椎间盘突出症的临床应用。方法：对125例148个椎间盘在CT引导下经皮穿刺达病变的椎间盘,缓慢注射浓度为60μg/ml臭氧气体15~20 ml;退针至神经根附近,缓慢注射浓度为40μg/ml臭氧气体5~10 ml,再注入利多卡因、曲安奈德、注射用腺苷钴胺和维生素B1混合液3~5 ml。结果：对患者进行随访,疗效分为优、良、中和差,本组优良率达91%。结论：CT引导下经皮穿刺盘内注射臭氧联合神经根阻滞治疗腰椎间盘突出症是一种有效、安全的微创方法。     

CT导向下经皮臭氧注射腰椎间盘溶解术的临床研究

目的：研究CT引导下臭氧注射腰椎间盘溶解术治疗腰椎间盘突出症的价值。方法：136例腰椎间盘突出症患者,经CT或MRI证实,保守治疗3月以上无效。手术在严格的无菌条件下进行。局麻,CT导向下用18 G穿刺针穿刺病变椎间盘并注射浓度为50μg/ml的臭氧气体20 ml,必要时在退针至椎间孔附近时,向椎旁组织内注入臭氧10 ml。依据Mac-Nab腰腿痛手术评价标准评价治疗效果。分析患者年龄、病程、突出程度、是否累及多个椎间盘等相关因素对疗效的影响。结果：136例患者随访3～24月,显效56例（41.2%）,有效69例（50.7%）,无效11例（8%）,总有效率近92%。术后无1例并发症。结论：CT引导下经皮臭氧注射腰椎间盘溶解术是治疗腰椎间盘突出症的一种安全有效的微创方法。     

CT引导下注射臭氧(O_3)治疗腰椎间盘突出症

目的评价CT引导下注射臭氧(O3)治疗腰椎间盘突出症的临床应用价值。方法在CT引导下对30例腰椎间盘突出症患者,采用盘内注射以及椎体后路突出物内注射臭氧(O3)治疗腰椎间盘突出症。结果治疗后30例患者经随访1个月至3个月,显效13例,有效15例,无效2例,总有效率达93.3%。结论CT引导提高了穿刺准确性,严格掌握适应证的情况下,椎间盘内臭氧(03)注射是治疗腰椎间盘突出症较有效且安全的方法。     

椎间盘内联合神经根周围注射臭氧治疗腰椎间盘突出症

目的：评价椎间盘内联合神经根周围注射臭氧治疗腰椎间盘突出症的疗效。方法：126例腰椎间盘突出症患者随机分成两组,单纯注射组57例,在血管机（DSA）引导下用21G穿刺针穿刺至病变椎间盘内,缓慢注射浓度60ug/ml的臭氧气体20ml;联合注射组69例,同法椎间盘内注射60ug/ml的臭氧20ml后,退针至椎间孔神经根周围,缓慢注入浓度为60ug/ml的臭氧10ml。根据MacNab方法,分别判定两组患者治疗后1、3、6、12个月的治疗效果。结果：单纯注射组治疗后总有效率分别为49.12%、61.40%、64.91%、59.65%。联合注射组为82.61%、81.16%、84.06%、75.36%。两组间疗效差异均有显著性意义。所有患者均未发现严重并发症。结论：椎间盘内联合神经根周围注射臭氧是治疗腰椎间盘突出症的一种有效的微创治疗方法。     

臭氧治疗术在复杂性腰椎间盘突出症治疗中的临床观察

目的探讨臭氧（O2-O3混合气体）治疗术在复杂性腰椎间盘突出症治疗中的效果。方法选择单纯腰椎间盘突出症患者70例,选择椎间盘内负压11例,腰椎间盘髓核摘除术后复发5例,伴椎管狭窄10例,伴腰椎退行性变、腰椎骨质增生、小关节退行性变30例,伴侧隐窝变窄4例,伴腰肌劳损10例,行CT引导下经皮穿刺臭氧治疗术,盘内注入臭氧量2～3ml,椎旁间隙注入臭氧量5～8ml,O3浓度为（30～40μg/ml）。合并腰肌劳损者,根据病理解剖特征,采用20ml一次性注射器抽取臭氧,对疼痛组织内行浸润注射,隔日1次,3次为一疗程。结果通过对70例腰椎间盘突出症患者及70例复杂性腰椎间盘突出症患者治疗后的对比,显示80%患者术后症状立即缓解,术后1周有效率达95%,随访3、6个月有效率可达96%。结论正确的临床诊断,准确的手术操作,以及合理的将臭氧联合应用于软组织损伤性疼痛中,可明显提高复杂性腰椎间盘突出症患者的治疗效果。     

The short- and medium-term effectiveness of CT-guided selective cervical nerve root injection for pain and disability

Introduction

CT-guided cervical nerve root injection with corticosteroid and/or local anesthetic is a recognized technique in the evaluation and treatment of cervical radiculopathy. There are few prospective studies on the efficacy of the various techniques employed in cervical nerve root injection. We present our results from a 1-year prospective series using a CT-guided anterolateral transforaminal approach for cervical nerve root injection of bupivacaine and dexamethasone.

Methods

Pain using a numeric rating scale was assessed at pre-injection, 15 min post-injection, 1 month, and 3 months. Disability was assessed using the Oswestry Neck Disability Index (NDI) questionnaire at pre-injection, 1 month post-injection, and 3 months.

Results

In total, 50 patients were followed for 3 months. The mean reductions in pain were: 15 min (77 %), 1 month (39 %), and 3 months (33 %). The mean reductions in NDI were: 1 month (26 %) and 3 months (also 26 %). Results were statistically significant.

Conclusions

CT-guided selective cervical nerve root injection in the treatment of cervical radicular pain and related disability produces statistically significant reductions in pain and disability to at least 3 months post-procedure.     

CT-guided nerve root block and ablation

We report our experience in performing 52 CT-guided peripheral nerve root blocks and 27 CT-guided nerve root ablations. The nerve root block procedures were performed as diagnostic tests to determine the clinical significance of equivocal herniated disk or foraminal stenosis (n = 33) and before nerve root ablations (n = 19). To evaluate the clinical significance of these nerve root blocks, we performed 52 procedures at the vertebral level where a herniated disk or foraminal stenosis had been identified on CT or MR images. In 51 of 52 cases, the procedures were successful in anesthetizing the intended nerve root, which allowed us to determine whether that particular nerve root was the source of pain. By relieving or not relieving pain, the results of the diagnostic nerve root blocks helped determine whether a protrusion or foraminal stenosis was clinically significant. The nerve root ablations were done exclusively for treatment of pain in patients with malignant disease. Significant relief of pain was obtained in 17 (63%) of 27 patients. The thoracic nerve ablations were the most successful (9/10 or 90%) because the correct thoracic nerve innervation to the offending lesion could be identified. The lumbosacral nerve ablation procedures were the least successful (6/14 or 43%) because the innervation of the pelvic neoplasms was complex, arising from multiple lumbosacral nerves that often were bilateral. Equivocal foraminal stenosis and disk protrusion are common findings on CT and MR imaging, and CT-guided nerve block procedures can help determine which of these findings are clinically significant. CT-guided nerve root ablations have limited efficacy but can help control pain in patients with a malignant disease, especially when the pain is in the distribution of a thoracic nerve dermatome.     

Cost comparison of nerve root infiltration of the lumbar spine under MRI and CT guidance

Objectives

To compare the costs of CT- and MR-guided lumbosacral nerve root infiltration for minimally invasive treatment of low back pain and radicular pain.

Methods

Ninety patients (54 men, 36 women; mean age, 45.5?±?12.8 years) underwent MR-guided single-site periradicular lumbosacral nerve root infiltration with 40 mg of triamcinolone acetonide. A further 91 patients (48 men, 43 women; mean age, 59.1?±?13.8 years) were treated under CT fluoroscopy guidance. Prorated costs of equipment use (purchase, depreciation and maintenance), staff costs based on involvement times and expenditure for disposables were identified for MR- and CT-guided procedures.

Results

Mean intervention time was 20.6 min (14–30 min) for MR-guided and 14.3 min (7–32 min) for CT-guided treatment. The average total costs per patient were €177 for MR-guided and €88 for CT-guided interventions. These consisted of (MR/CT guidance) €93/29 for equipment use, €43/35 for staff and €41/24 for disposables.

Conclusions

Lumbosacral nerve root infiltration using MRI guidance is still about twice as expensive as infiltration using CT guidance. Given the advantages of no radiation exposure and possible future decrease in prices for MRI devices and MR-compatible injection needles, MR-guided nerve root infiltration may become a promising alternative to the CT-guided procedure.

Key Points

? MR-guided nerve root infiltration therapy is now technically and clinically established. ? Costs using MRI guidance are still about double those for CT guidance. ? MR guidance involves no radiation exposure to patients and personnel. ? MR-guided nerve root infiltration may become a promising alternative to CT.     

Spinal CT-guided interventional procedures for management of chronic back pain

PURPOSE: Image-guided interventional procedures have arisen as an alternative for management of back pain, with controversial indications and efficacy. This study describes the technique, clinical impact, and complications of computed tomography (CT)-guided infiltrations for the management of chronic back pain. MATERIALS AND METHODS: One hundred eleven patients with chronic back pain treated with CT-guided infiltrations were studied prospectively. Procedures performed included nerve root, facet joint, epidural, and sacroiliac joint blocks. Pain intensity was evaluated with use of a visual analog scale. RESULTS: Two hundred twenty-two infiltrations were performed in 111 consecutive patients. After 18 months of follow-up, pain improvement lasted for a mean duration of 9 months and the complication rate was less than 1%. Moderate to good pain response was seen in 95% of followed patients and 4% of patients required surgery. CONCLUSION: Spinal CT-guided infiltration constitutes an effective therapy for chronic back pain. This series confirms a low complication rate, good response, and high therapeutic value.     

Role of interventional radiology in pudendal neuralgia: a description of techniques and review of the literature

Purpose

The authors sought to evaluate indications, technical feasibility and clinical efficacy of computed tomography (CT)-guided pudendal nerve infiltration in patients with chronic anoperineal pain by reviewing the role of the CT technique in their personal experience and in the recent interventional literature.

Materials and methods

Twenty-eight women, mean age 50 years, and with a diagnosis of pudendal neuralgia on the basis of clinical and electromyographic criteria were enrolled in the study. CT-guided pudendal nerve injections were performed during three consecutive sessions held 2 weeks apart. In each session, patients received two percutaneous injections: one in the ischial spine, and the other in the pudendal (Alcock’s) canal.

Results

One patient dropped out of the study after the first session. At clinical assessment, 24h h after treatment, 21/27 patients reported significant pain relief. At follow-up at 3, 6, 9 and 12 months, 24/27 patients reported a≥20% improvement in the Quality of Life (QOL) index. Conclusions. In pudendal nerve entrapment, CT-guided perineural injection in the anatomical sites of nerve impingement is a safe and reproducible treatment with a clinical efficacy of 92% at 12 months.     

CT引导下经皮穿刺医用生物蛋白胶治疗神经根囊肿

目的探讨CT引导下经皮穿刺纤维蛋白粘合剂治疗神经根囊肿的疗效。材料与方法对9例骶神经根囊肿患者,在高分辨力CT引导下定位,行腰穿针经骶孔刺入神经根囊肿内,抽尽囊肿内液体。将医用生物蛋白胶(FG)的主体和催化剂溶解液,同时等量注入囊腔内。结果9例骶神经根囊肿患者经治疗后,神经压迫症状解除,术后随诊1～19个月无神经损伤、无感染、无复发。术后CT复查显示囊肿内CT值增高,无脑脊液存留。MRI示囊肿消失。结论CT引导下经皮穿刺引流囊肿内注射FG粘合剂治疗骶神经根囊肿是一种安全、可靠、经济、有效的新疗法。其远期疗效有待于进一步观察。     

Postoperative nerve root displacement and scar tissue. A prospective cohort study with contrast-enhanced MR imaging one year after microdiscectomy

PURPOSE: To investigate the association between postoperative nerve root displacement and epidural scar tissue. MATERIAL AND METHODS: One hundred patients who had undergone lumbar microdiscectomy were included in a prospective cohort study with a 1-year follow-up. The patients were classified as failures or successes at the 12-month follow-up according to a clinical score. Patients with signs of recurrent disc herniation on MR were excluded from the study. All the 13 patients classified as failures were investigated with MR at the 1-year follow-up, and 40 patients classified as successes were picked at random for MR imaging; thus MR was performed in 53 patients. The MR images were independently evaluated by two neuroradiologists. The images were rated according to the presence or absence of nerve root displacement at the surgically treated disc interspace. Scar formation was rated according to two different classification systems. RESULTS: Nerve root displacement was observed in 13 patients. No evidence of scar formation was found in 4 patients, a small amount in 11, intermediate in 37 and extensive scar formation in 1 patient. No association between nerve root displacement and the amount of scar tissue was found. CONCLUSION: Postoperative nerve root displacement seems to be an independent clinical entity not associated to postoperative scar tissue.     

Cervical nerve root blocks: indications and role of MR imaging

PURPOSE: To examine whether magnetic resonance (MR) imaging findings of the cervical spine can predict pain relief after selective computed tomography (CT)-guided nerve root block and thus assist in the appropriate selection of patients who are suitable for this procedure. MATERIALS AND METHODS: Sixty consecutive patients with cervical radicular pain were examined with MR imaging and then treated with CT-guided cervical nerve root blocks (CNRBs). Various MR imaging findings were assessed and compared in terms of associated pain relief after CNRB. Pain relief was graded (0%-100%) by using a visual analogue scale (VAS). The relationship between MR imaging findings and level of pain relief was tested by using Mann-Whitney U and Kruskal-Wallis tests. RESULTS: The mean percentage of pain reduction at VAS grading was 46%. There was a significant relationship between pain relief level and both location of disk herniation (mean pain reductions of 41% at median or mediolateral locations and 64% at foraminal locations, P =.034) and location of nerve root compromise (mean pain reductions of 19% at intraspinal, 45% at foraminal entrance, and 58% at foraminal locations; P =.019). There was an inverse relationship between pain relief level and absence or presence of spinal canal stenosis (mean pain reductions of 29% when stenosis present and 53% when stenosis absent, P =.013). Other parameters were not significantly related to pain relief. CONCLUSION: MR imaging of the cervical spine assists in the appropriate selection of patients suitable for CNRB. Patients with foraminal disk herniation, foraminal nerve root compromise, and no spinal canal stenosis appear to have the greatest pain relief after this procedure.