Pain therapy (spine) in the open high-field MRI
Back pain is considered to be Europe’s number one disease and contributes to a majority of individual and economic problems. 90% of all Germans will suffer from back pain during their life time.
The spine is our body’s scaffold and is exposed to many burdens within a lifetime. The increasingly inert lifestyle of our society further increases such burdes and contributes to increased degeneration of the spine and ensuing back pain. 90% of all cases of back pain resovle spontaneously and do not require invasive therapeutic methods. This type of back pain is defined as unspecific back pain. Typically this type of back pain has a good prognosis and doesn not require extensive imaging diagnostics. Although most acute cases of back pain resolve on their own – if neccessary with physiotherapeutic treatment or pain medication – these symptoms can become chronic and indicate structural disease. Apart from disc protrusion, joint arthrosis, disc or vertrabral body degeneration can cause to back pain. If the pain is not limited to merely the back, but also radiates into other areas of the body (i.e. legs, feet etc), this can indicate a disc protrusion. Should the impingement of the nerve root worsen, palsy of the extremities can ensue. In these cases, speedy and individual pain management is neccessary to prevent permanent damadge and pain chronification. Even if the pain should already be chronic, a secured organic cause can be the base for a successful therapeutic regimen. The decision for or against therapeutic intervnetion can only be made by an experienced radiologist after a detailed converation with the patients and a precise physical examintaion.
Treatment of backpain
Modern treatment strategies are based on the multi-factoral cause of back pain and are the basis for individual treatment programs with the goal of a complete pain remission.
Individual Planning
Initially, therapeutic options should be considered to avoid open surgery at the spine. At the beginning of every therapeutic regimen, conservative measures such as heat treatment, physiotherapy or pain medication should be considered. All of these options mostly result in temporary pain relief of the patient. Should these attempts fail, minimally invasive options exist. These modern and safe procedures can often prevent or postpone most open disc surgeries. Apart from standard x-ray or CT-monitoring, MRI-guided infiltration therapt of the nerve roots, the facet joints, the sacroiliac joints or the sympathetic trunk can be performed under precise image guidance without the exposure to ionizing radiation.
Pain therapy in the open MRI
Our clinic offers a modern diagnostic and therapeutic environment. As of late, the Charité as an open high-field MRI (1.o Tesla Panorama HFO Phiips Health Care) available. The advantages of this system lie in the good accessablility of the patient and the excellent image quality of spinal diagnostics, which is comparable to that of standard tunnel systems.
Left: Open high-field MRI (1.0 T Panorama HFO, Philips Healthcare, NL). Right: Demonstration of an open MR-guided pain therapy at the lumbar spine. The patient is awake and only local anaesthesia is neccessary.
The open MRI enables a safe identification of sensitive anatomic structures, such as the vertebral disc, the vertebral body and joints, the spinal nerve roots and the spinal chord. Under real-time imaging, a thin injection cannula is advanced to the region of the spine, responsible for the pain and analgetic and antiinflammatory medicine is injected. This procedure is performed within approx. 40 min and does not require the hospitalization of the patient. It is the goal of this therapy to break through the cycle of nerve root irritation, swelling, inflammation and pain. In most cases, rapid pain reduction is possible.
Advantages of the open MRI:
- MRI is the most precise method for spinal diagnostics.
- Superior soft tissue contrast, compared to conventional x-ray imaging.
- Multi-planar imaging.
- Monitoring of injected medicine without the need for nephrotoxic contrast agent.
- Use of a radiation-free imaging modality, which is especially useful for pediatric interventions or a serial therapeutic regimen in young adolescents or adutls.
Advantages of open MR-guided injection therapy:
- minimally invasive and low-risk procedure
- local anaesthesia only
- Break-out from pain spiral
- Ideal for young patients, since the regimen is serial and radiation-free imaging is favourable.
- open MR-guided intervnetions with potentially increased safety and efficiency, compared to CT or x-ray guided interventions.
Florian Streitparth
Thula Walter (Trans.)
Felix Güttler (Ed.)
