Periradikuläre Injektionstherapie
Indications
- Nerveroot irritation at the cervical or lumbar spine, due to disc protrusions or prolapses with radicular pain at the extremities.
- Recurrent, chronic pain.
- Inoparable patients.
- For post-operative rehabilitation.
- Intolerance to systemic or oral analgetics.
- Pain caused by spinal scarring after open surgery.
Case 1
31 year old patient with back pain and radiation into the right leg and heel (so-called “radicular” pain). Left: T2-w FSE sequence, sagittal view – depiction of a lumbar disc protrusion at L5/S1. Right: Corresponding transverse image, depiction of the protrusion with right medio-lateral orientation and herniation of the descending spinal nerve S1.
Disc protrusions and prolapses can be the cause for nerve root irritation at the cervical or lumbar spine and can ensue with severe pain syndromes for the afflicted patient. Nerveroot inflammation or scarring after open surgery at the site can also be the cause for disc-associated pain symptoms. Periradicular (SIT – access directly at the nerve root) and epidural therapies (access through the spinal canal) are differentiated. With these minimally invasive methods an injection needle can be advanced directly to the inflamed nerveroot under constant open MRI guidance.
Case 2
Depiction of needle insertion at the afflicted S1 nerve root on the right under constant “radiation-free” imaging. Right: Injection control at the spinal nerve. The patient reported on complete remission of pain after the second injection.
After control and needle positioning with interactive MRI, a mixture of analgetics and anti-inflammatory medication was injected through the cannula. This way the medicine is brought directly to the inflamed nerve root. After the application, the dispersion of the injected fluid can be documented with a special MRI sequence (SPIR) and therapeutic success can be verified.
It is the decided goal of the therapy to reduce and break through the pain spiral of nerve root irritation, inflammation and pain. In most cases the therapy causes fast and long-lasting relief of pain. It is effective to repeat the therapy to secure and ensure long-lasting pain relief.
Florian Streitparth
Felix Güttler (Ed.)
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