Interventional CT and MRI combined with microendoscopy for low back pain therapy

Abstract

SummaryAcute and chronic back pain is the second most significant medical problem world-wide. Microinvasive CT-guided treatments of the spine are routine in our department. For this study, newly-developed procedures in an open 0.064 T and 0.2 T magnetic resonance imaging (MRI) scanner were compared with interventional CT. 340 patients who underwent microtherapeutic treatment took part in the study: 80 had percutaneous laser nucleotomies (PLNT), 100 had facet joint and 100 periradicular therapies (PRT); another 60 patients had ilio-sacral joint infiltrations. For PLNT a Neodymium YAG laser was used; for scar tissue treatment a Holmium YAG laser was used; for the other treatments, local anesthesia and cortisone, and 1.0 cm3 50–96% ethanol (used for denervation in treatment of chronic facet joint pain) were instilled. 100 endoscopic treatments with systems 0.29–1.8 mm in diameter were undertaken: 20 on the facet joints, 80 inside the foramen intervertebrae, before and inside the disc after laser nucleotomy. Before treatment, 340 patients had a pain score of 70–100 on a visual analogue scale (VAS). The average pain score before therapy was 86%, after treatment it decreased to 7% (6 month follow-up). Neurologic deficits improved in 87% of cases after endoscopic discectomy (73% at follow-up). In MRI open access allows near real-time guidance of instruments. But the last 3.5 mm at the tip of the instruments is not easy to define. Interventional MRI is a routine technique in low risk areas, as in facet and ilio-sacral joints. CT-guidance is now the standard technique. In the future, endoscopes, drugs, lasers, RF-probes, cryosticks and mechanical instruments will be guided inside tomographic scanners for routine spinal work.