Abstract
BackgroundImage guided spinal injections are successfully used in the management of low back pain and sciatica. The main benefit of CT-guided injections is the safe, fast and precise needle placement, but the radiation exposure remains a serious concern. The purpose of the study was to test a new institutional low-dose protocol for CT-guided periradicular injections in lumbar spine to reduce radiation exposure while increasing accuracy and safety for the patients.MethodsWe performed a retrospective analysis of a prospective database during a 4-month period (Oct-Dec 2011) at a German University hospital using a newly established low-dose-CT-protocol for periradicular injections in patients suffering from lumbar disc herniation and nerve root entrapment. Inclusion criteria were acute or chronic nerve root irritation due to lumbar disc hernia, age over 18, compliance and informed consent. Excluded were patients suffering from severe obesity (BMI > 30), coagulopathy, allergy to injected substances, infection and non-compliant patients. Outcome parameters consisted of the measured dose length product (mGycm2), the amount of scans, age, gender, BMI and the peri-interventional complications. The results were compared to 50 patients, treated in the standard-interventional CT-protocol for spinal injections, performed in June-Oct 2011, who met the above mentioned inclusion criteria.ResultsA total amount of 100 patients were enrolled in the study. A significant radiation dose reduction (average 85.31%) was achieved using the institutional low-dose protocol compared to standard intervention mode in CT-guided periradicular injections in lumbar spine. Using the low-dose protocol did not increase the complications rate in the analyzed cohort.ConclusionsLow-dose-CT-protocols for lumbar perineural injections significantly reduce the exposure to radiation of non-obese patients without an increase of complications. This increases long-time patient safety of stochastic radiation effects.
Highlights
Image guided spinal injections are successfully used in the management of low back pain and sciatica
The stochastic radiation effect due to a cumulative radiation dose in patients suffering from degenerative spinal disorders implicating a long-term therapy and use of spinal injections is often used as an argument against the use of CT-guidance [9]
A total amount of 50 perineural injections were performed in the low-dose protocol at the lumbar spine
Summary
Image guided spinal injections are successfully used in the management of low back pain and sciatica. The main benefit of CT-guided injections is the safe, fast and precise needle placement, but the radiation exposure remains a serious concern. The purpose of the study was to test a new institutional low-dose protocol for CT-guided periradicular injections in lumbar spine to reduce radiation exposure while increasing accuracy and safety for the patients. The main benefit of CT-guided spinal injections is the precise and safe needle placement, especially in patients with severe degenerative spinal changes. Despite the safety and precision of image-guided interventions, the radiation exposure of the patient and interventionalist still remains a serious concern [3,4,5,6,7,8]. The aim of the following article was to test a new institutional low-dose-protocol for CT-guided periradicular injections in lumbar spine to minimize the radiation exposure and increase patients safety
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