CT-guided Injection Research Articles

PSY13 - Efficacy and Tolerability of CT-Guided Epidural Steroid Injections and Pharmacotherapy for Managing Chronic Low Back Ache with Radiculopathy

PSY13 - Efficacy and Tolerability of CT-Guided Epidural Steroid Injections and Pharmacotherapy for Managing Chronic Low Back Ache with Radiculopathy

Massive Subcutaneous and Mediastinal Emphysema with Little Pneumothorax Treated by Surgery after Pulmonary Radiofrequency Ablation

IntroductionPulmonary radiofrequency ablation (RFA) is one of thetreatment options for primary and metastatic lung tumorsand has had minimal procedure-related complications [1].The most frequent complication related to pulmonary RFAis pneumothorax [2]; mediastinal emphysema is rare. Thepatient may develop only subcutaneous and mediastinalemphysema, with little pneumothorax. This is a specificclinical condition.Here we describe a case of massive subcutaneous andmediastinal emphysema, with the patient developing littlepneumothorax after pulmonary RFA for metastatic lungtumors. The complication was treated by surgical sutureclosure of the fistula in lung parenchyma after an unsuc-cessful attempt to inject liquid embolization material undercomputed tomography (CT)-guided navigation.Case ReportA 56-year-old man was referred to our hospital for a sec-ond opinion regarding the treatment of recurrent metastaticlung tumors from esophageal carcinoma. He had a historyof pulmonary resection in bilateral lungs for metastatictumors. Because of limited pulmonary function, pulmonaryRFA was selected for the treatment of an 8-mm-diametertumor located immediately below the visceral pleura of theleft lung at the department of radiology in our hospital(Fig. 1A, B). Before pulmonary RFA, the creation of anartificial pneumothorax was tried for pain relief and pro-tection of the chest wall from thermal injury. However, itwas not successful as a result of pleural adhesion. Afterpulmonary RFA, CT scan revealed that subcutaneous andmediastinal emphysema with slight pneumothorax wasevident and progressively advanced, whereas pneumotho-rax improved (Fig. 1C). CT-guided injection of liquidembolization material into the fistula in lung parenchymawas attempted 6 days after the pulmonary RFA, but it wasunsuccessful. The patient’s voice gradually changed. Fol-low-up CT scan 10 days after the pulmonary RFA revealedthe possibility of the collapse of superior vena cava andsubsequent hypovolemic shock by progressive mediastinalemphysema (Fig. 1D).The patient was referred to the department of thoracicsurgery for a surgical procedure, and an emergent operationwas performed on the same day. There was moderate to

CT-guided cervical transforaminal epidural steroid injections: Technical insights

Recent studies have described the safety and efficacy of computed tomography (CT)-guided cervical transforaminal epidural steroid injections with both the anterolateral and posterior approach. Although fluoroscopy is the most common form of image guidance for these procedures, CT guidance offers many advantages. However, some key features of CT guidance in these procedures need to be considered to ensure safe and technically successful outcomes.

Outcome Study of Real-time MR-guided Cervical Periradicular Injection Therapy in an Open 1.0 Tesla MRI System

To evaluate the accuracy, safety, and efficacy of cervical nerve root injection therapy using magnetic resonance guidance in an open 1.0 T MRI system. Between September 2009 and April 2012, a total of 21 patients (9 men, 12 women; mean age 47.1 ± 11.1 years) underwent MR-guided cervical periradicular injection for cervical radicular pain in an open 1.0 T system. An interactive proton density-weighted turbo spin echo (PDw TSE) sequence was used for real-time guidance of the MR-compatible 20-gauge injection needle. Clinical outcome was evaluated on a verbal numeric rating scale (VNRS) before injection therapy (baseline) and at 1 week and 1, 3, and 6 months during follow-up. All procedures were technically successful and there were no major complications. The mean preinterventional VNRS score was 7.42 and exhibited a statistically significant decrease (P < 0.001) at all follow-up time points: 3.86 ± 1.53 at 1 week, 3.21 ± 2.19 at 1 month, 2.58 ± 2.54 at 3 months, and 2.76 ± 2.63 at 6 months. At 6 months, 14.3 % of the patients reported complete resolution of radicular pain and 38.1 % each had either significant (4-8 VNRS score points) or mild (1-3 VNRS score points) relief of pain; 9.5 % experienced no pain relief. Magnetic resonance fluoroscopy-guided periradicular cervical spine injection is an accurate, safe, and efficacious treatment option for patients with cervical radicular pain. The technique may be a promising alternative to fluoroscopy- or CT-guided injections of the cervical spine, especially in young patients and in patients requiring repeat injections.

CT-guided injection technique into intervertebral discs in the ovine lumbar spine

Disc injection to create intervertebral (IVD) disc degeneration (IVDD) has been reported in ovine models, but the techniques have not been thoroughly described. The current ex vivo study aimed to evaluate a computed tomography (CT)-guided injection technique into IVDs in the ovine lumbar spine. Insertion of needles into the nucleus pulposus was assessed by gross anatomic dissection in two lumbar segments (group A), and injection of liquid within the disc was assessed by discography in six segments (group B). The pathway of the needle was simulated on computer after an initial CT scan, followed by control of the insertion process via a laser beam and monitoring scans. In group A, 20 insertions were assessed and 17 needles (85 %) were successfully positioned in the nucleus pulposus. In group B of 30 injections, the rate of success was 90 %. The current study provides useful clinical information that will help surgeons working with an ovine model for research on IVDD. This model could also be useful to train less experienced surgeons or radiologists to disc injection. This CT-guided injection seems to offer several advantages such as ease of use, good success rate and safety to important nervous and vascular structures.

Optimal Contrast Concentration for CT-Guided Epidural Steroid Injections

Contrast is used in CT-guided epidural steroid injections to ensure proper needle placement. Once injected, undiluted contrast often obscures the needle, hindering subsequent repositioning. The purpose of this investigation was to establish the optimal contrast dilution for CT-guided epidural steroid injections. This investigation consisted of an initial phantom study, followed by a prospective, randomized, single-center trial assessing a range of contrast dilutions. In the phantom study, a phantom housing a chamber containing a 22-gauge needle and various dilutions of contrast was scanned, and images were evaluated for needle visibility. On the basis of these results, concentrations of 66, 100, 133, and 150 mg/mL iodine were selected for evaluation in a clinical study. Patients presenting for CT-guided epidural steroid injections were randomly assigned to a contrast dilution, and images from the procedure were evaluated by 2 readers blinded to the contrast assignment. Needle visibility was scored by use of a 5-point scale. In the phantom study, the needle was not visible at contrast concentrations of ≥133 mg/mL. In the clinical study, needle visibility was strongly associated with contrast concentration (P < .0001). Significant improvements in visibility were found in 66 mg/mL and 100 mg/mL compared with higher iodine concentrations; no difference was found comparing 66 mg/mL with 100 mg/mL iodine. Neither injection location (cervical versus lumbar) nor technique (interlaminar versus transforaminal) influenced visibility scores. For CT-guided epidural steroid injections, the optimal contrast concentration is 66-100 mg/mL iodine. Because these concentrations are not commercially available, proceduralists must dilute their contrast for such procedures.

Ultrasound-guided versus computed tomography-controlled periradicular injections in the middle and lower cervical spine: a prospective randomized clinical trial

We conducted this study to evaluate accuracy, time saving, radiation doses, safety, and pain relief of ultrasound (US)-guided periradicular injections versus computed tomography (CT)-controlled interventions in the cervical spine in a prospective randomized clinical trial. Forty adult patients were consecutively enrolled and randomly assigned to either a US or a CT group. US-guided periradicular injections were performed on a standard ultrasound device using a broadband linear array transducer. By basically following the osseous landmarks for level definition in "in-plane techniques", a spinal needle was advanced as near as possible to the intended, US-depicted nerve root. The respective needle tip positioning was then verified by CT. The control group underwent CT-guided injections, which were performed under standardized procedures using the CT-positioning laser function. The accuracy of US-guided interventions was 100%. The mean time to final needle placement in the US group was 02:21 ± 01:43 min:s versus 10:33 ± 02:30 min:s in the CT group. The mean dose-length product radiation dose, including CT confirmation for study purposes only, was 25.1 ± 16.8 mGy cm for the US group and 132.5 ± 78.4 mGy cm for the CT group. Both groups showed the same significant visual analog scale decay (p < 0.05) without "inter-methodic" differences of pain relief (p > 0.05). US-guided periradicular injections are accurate, result in a significant reduction of procedure expenditure under the avoidance of radiation and show the same therapeutic effect as CT-guided periradicular injections.

A phase I dose-escalation study of intratumoral herpes simplex virus-1 mutant HSV1716 in pediatric/young adult patients with refractory non-central nervous system solid tumors.

10047 Background: HSV1716 is a mutant herpes simplex virus type 1 deleted in the RL1 gene which encodes the protein ICP34.5, a specific determinant of virulence. Mutants lacking the RL1 gene are capable of replication in actively dividing cells but not in terminally differentiated cells – a phenotype exploited to selectively kill tumor cells. Studies in adult patients with high grade glioma, melanoma and squamous cell carcinoma report that HSV1716 is safe when administered by intra-tumoral injection. This is the first study of HSV1716 in pediatric/young adult patients. Methods: The primary endpoint of the study is to assess safety of intratumoral HSV1716 in pediatric/young adult patients, and to determine any dose-limiting toxicities (DLT) at the doses given. Patients undergo long-term follow up in accordance with FDA guidelines for viral vectors. The secondary endpoints of the study are to measure: (i) antiviral immune response; (ii) systemic viremia and viral shedding and (iii) the antitumor activity of HSV1716 by radiological response within the confines of a Phase I study. Patients aged 7 to 30 with solid non-CNS tumors refractory to standard therapy (or for which no therapy exists) are eligible for the study provided the target lesion is accessible to image-guided injection. Eligible patients receive a single dose of HSV1716 (Virttu Biologics Limited) at either 105 or 2x106 plaque forming units (pfu) HSV1716 administered directly into the tumor via ultrasound or CT-guided injection by an interventional radiologist. Tumor response between baseline and day 28 is assessed by modified RECIST criteria. Patients showing at least stable disease may receive up to a 3 additional doses of HSV1716. Results: Recruitment of the first cohort of 3 patients has been completed without DLT or procedure related severe adverse events. In the second cohort, 2 patients have been treated without DLT or procedure related SAE. Conclusions: The trial is in progress and the study is open to recruitment. Clinical trial information: NCT00931931.

The percutaneous stabilisation of the sacroiliac joint with hollow modular anchorage screws: a prospective outcome study

The use of percutaneous iliosacral screw fixation as a treatment of sacroiliac joint pain has been reported to be successful. This study was a prospective single surgeon series to evaluate the short-term outcomes of patients who underwent percutaneous sacroiliac joint stabilisation. Between July 2004 and February 2011, 73 patients underwent percutaneous sacroiliac joint fusion in our unit. All patients completed a short form (SF)-36 questionnaire, visual analogue pain score and Majeed scoring questionnaire prior to treatment and at last follow-up. 55 patients (9 male and 46 female) completed follow-up. The average follow-up period was for 36.18 months (range 12-84). The mean preoperative SF-36 scores were 26.59 for physical health and 40.38 for mental health. The mean postoperative SF-36 scores were 42.93 for physical health and 52.77 for mental health. The mean visual analogue pain scores were 8.1 preoperative and 4.5 postoperative. The mean pelvic specific scoring were 36.9 preoperative and 64.78 postoperative. We noted that patients who had previous instrumented spinal surgery did significantly worse than those who had not. We had two nerve root-related complications. We conclude that in selected patient group who respond positively to CT-guided injection, a percutaneous SI joint stabilisation is beneficial in effecting pain relief and functional improvement.

CT-guided percutaneous injection of the fibrin glue by 'double needle' technique for the treatment of sacral cysts

Objective To analyze the efficacy and safety of CT-guided percutaneous injection of the fibrin glue by“double needle”technique to treat sacral cyst. Methods Clinical data of 20 cases with“double-needle”injection of fibrin glue technology to treat sacral cyst were retrospectively analyzed.All patients had varying degrees of sacral nerve root compression symptoms.The treatment for sacral cyst was carried out after clear diagnosis was made.On the basis of CT-guided percutaneous injection of fibrin glue,the improved CT-guided percutaneous injection of fibrin glue by“doubleneedle”technique was used to treat these patients.The average dose of fibrin glue was (5.9±2.4) ml.The clinical results of improvement as to pain and neurological function were evaluated after follow-up of an average of 17 months.The assessment criteria were as follows: excellent,complete resolution of signs and symptoms,with the patient returning to his or her regular employment and no recurrence of cysts during 1 year of follow-up,good,symptoms and signs in the legs and perineal region resolved but with persistent pain in the lumbosacral region,which did not interfere with the patient's regular work (the cysts did not recur for 6 months during follow-up),fair,no improvement in clinical symptoms,but a decrease in cyst size on the imaging study,poor,no improvement in clinical symptoms and no observed changes in cyst size in imaging studies or recurrence. Results Most patients experienced some degree of pain relief and functional improvement after fibrin glue therapy,with most experiencing complete or marked resolution of clinical symptoms.Nine patients reported excellent recovery,8 reported good recovery,2 reported fair recovery,and 1 reported poor recovery.The overall percentage of positive outcomes (excellent and good recovery) was 85%.No serious postoperative complications were discovered. Conclusions CT guided percutaneous injection of the fibrin glue by“double needle”technique to treat sacral cyst is an ideal method.“Double needle”technique is simple,safe and reliable. Key words: Sacral cyst; Punctures; Fibrin tissue adhesive; Radiology,interventional;

Radiation Dose for 345 CT-Guided Interlaminar Lumbar Epidural Steroid Injections

CT guidance is increasingly being used to localize the epidural space during epidural steroid injections. A common concern is that CT may be associated with significantly higher radiation doses compared with conventional fluoroscopy. The goal of this retrospective study was to determine the average dose-length product and effective dose delivered while interlaminar epidural steroid injections are performed and allow comparison with other modalities. A total of 281 patients who had undergone 345 consecutive CT-guided epidural steroid injections of the lumbar spine were evaluated for radiation exposure. The dose-length product for each scan was derived from the CT dose index volume and scan length. Effective dose was then calculated from the dose-length product and a κ coefficient of 0.015. Procedure time was calculated from the PACS time stamp on the scout image to the last CT image of the last image series. The average dose-length product across all procedures was 89.6 ± 3.33 mGy·cm, which represents an effective dose of 1.34 ± 0.05 mSv. No complications from the procedure were observed, and average procedure time was 8 minutes. The use of a stationary table and an intermittent scanning technique allow for short procedures and doses that are significantly lower than those of conventional diagnostic CT scans. Furthermore, because CT dose index overestimates radiation dose in stationary table procedures, the actual radiation dose may be even lower than stated here.

CT-Guided Percutaneous Chemoablation using an Ethanol-Ethiodol-Doxorubicin Emulsion for the Treatment of Metastatic Lymph Node Carcinoma: A Comparative Study

Current therapies for metastatic lymph node (LN) are a major burden on health-care systems. Alternative such as percutaneous chemoablation using interstitial injection of ethanol or ethanol-ethiodol-drug(s) mixture (EEM) has been successfully applied to solid tumor ablation of the liver, adrenal glands, lymph nodes and others. However, EEM chemoablation efficacy on two most frequent clinical lymph node presentation, isolated or confluent, has not yet been determined. This study was designed to compare the therapeutic effects of CT-guided percutaneous EEM injection (PEEMI) on patients presenting with single or multiple confluent metastatic LN localizations from various carcinoma. Thirty six patients with metastatic LN carcinoma at various anatomical regions were enrolled from 2009 to 2010 over a nine month period. They were separated into two groups: group A includes 24 single isolated metastatic lymph nodes and group B includes 12 multiple and confluent nodes. The primary end point was the ablative efficacy of PEEMI. The intratumoral (IT) EEM distribution and the occurrence of reflux were recorded. Adjuvant systemic chemotherapy was administered after the procedure. Contrast-enhanced CT scans were performed during procedure and follow-up. Six patients were tested for Fluorodeoxyglucose (FDG) fixation before and after the procedure. For group A the EEM IT distribution-to-tumor ratio was 100% vs. 50% to 80% for group B (t = 11.5, p < 0.05). The reflux frequency was 80% for group A versus 30% for group B. For group A, a complete response (CR) rates of 45.8%, 70.8%, 91.7% and a partial response (PR) rates of 54.2%, 29.2%, 8.3% were obtained at 3, 6 and 12 months after therapy. Regarding group B, a CR rate of 0%, 0%, 0% and PR rate of 16.7%, 50%, 58.3% were observed at similar period of time. Standardized rate by direct method was performed and the CR rate (74.5%) for group A was higher than for group B. The tumor FDG uptake was lower 6 months after PEEMII compared with the preoperative images. Five patients presenting with concomitant lung metastasis, had a good local response-node size reduction on postoperative CT scanning, but no response on lung nodules that were progressing. No serious adverse events were observed. A few patients had mild pain during the procedure, which resolved with peritumor injection of local anesthetic. No needle tract seeding or infection occurred. CT-guided PEEMI treatment is a simple, fast and predictable procedure that has better effectiveness on single, well circumscribed metastatic lymph node than on multiple and confluent ones. Technical improvements are expected to bring better results on large nodes that should be confirmed on larger group of patients.

Computed Tomography-guided Periradicular Injections on Cervical and Lumbar Spine

Treating sciatic pain caused by intervertebral disk herniation remains challenging. Not only does the symptomatology put a strain on patients, it is also of enormous socioeconomic impact. Next to conservative measures that include physical therapy and adequate pain medication, surgery—absolutely indicated in cases of cauda syndrome and severe motor deficit—seems to be the treatment of choice. In some cases though surgery seems to have identical long-term results compared with conservative management. Yet, neither conservative measures nor surgery always provide sufficient results. Moreover, there are a number of patients who do on the one hand not respond to conservative therapy, but do on the other hand not have the indication for surgery. As a result alternative, minimally invasive, image-guided therapies, such as periradicular therapy, have been introduced in recent years. Periradicular therapy is indicated in patients with radicular pain symptoms or radiculopathy, which may be caused by foraminal or spinal canal stenosis, tumors, or spondylolisthesis, and has become popular in the treatment of lumbar radicular complaints due to disk herniation. This review article focusses on different aspects of CT-guided periradicular injections and emphasizes a selection of practical considerations of important interventions at different spinal regions.

Ultrasound-guided versus Computed Tomography-controlled facet joint injections in the middle and lower cervical spine: a prospective randomized clinical trial

A prospective randomized clinical trial was conducted to evaluate accuracy, time-saving, radiation doses and pain relief of ultrasound-guided (US) facet joint injections versus Computed Tomography (CT)-controlled interventions in the cervical spine. Forty adult patients were consecutively enrolled and randomly assigned to the US- or CT group. US-guided facet joint injections were performed on a standard ultrasound device using a broadband linear-array transducer. The corresponding comparison group underwent CT-guided instillations which were performed under standardized procedures using the CT-positioning laser function. The accuracy of ultrasound-guided interventions was 100%. The mean time (min:sec) to final needle placement in the US group was 04:46 versus 11:12 (p<0.05) in the CT group for one injected level, and 05:49 in the US group versus 14:32 (p<0.05) in the CT group for two injected levels. The mean dose-length product (DLP, mGy*cm) radiation dose, including CT confirmation for study purposes only, was 27.6 for the US group versus 88.2 in the CT group (p<0.05) for one injected level, and 32.5 in the US group versus 205.0 in the CT group (p<0.05) for two injected levels. Both groups showed the same significant visual-analog-scale (VAS) relief in pain (p<0.05), without any "inter-methodic" differences (p>0.05). US-guided intra-articular injections show the same therapeutic effect as CT-guided intra-articular injections and result in a significant reduction of procedure duration without any exposure to radiation.

Immediate Pain Response Does Not Predict Long-Term Outcome of CT-Guided Cervical Transforaminal Epidural Steroid Injections

Imaging-guided cervical transforaminal epidural steroid injections have been shown to decrease verbal numerical pain scores and improve functionality (Roland Morris Disability Index). These injections are often administered in combination with local anesthetic. The purpose of this study was to determine if the immediate postprocedure VNPS predicts the long-term effectiveness of the injection. A quality assurance data base review of 247 patient records was used to document the VNPS and RMDI of patients undergoing a single CT-guided CTESI. Pain scores were recorded before the procedure, immediately after the procedure, at 2 weeks, and at 2 months. The RMDI was recorded before the procedure, at 2 weeks, and at 2 months. Spearman rank correlation analysis and logistic regression models were used to determine if the immediate postprocedure or 2-week VNPS correlated with or predicted the longer-term VNPS and RMDI as measured at 2 weeks and 2 months. There was not a strong correlation between the pain score obtained immediately after the procedure and the 2-month outcome of the VNPS or RMDI. The pain scores at 2 weeks did correlate with the 2-month outcomes. The 2-week VNPS also was a significant predictor of patients who would achieve a >50% improvement in VNPS or RMDI at 2 months. Pain scores obtained immediately after completion of a single CT-guided CTESI do not predict the long-term effectiveness of this procedure. However, patient response at 2 weeks does correlate with the long-term effectiveness of these injections as measured by the VNPS and the RMDI.

CT-guided percutaneous puncturing and injection of sclerosing agent for the treatment of lung bullae: its clinical application

CT-guided percutaneous puncturing and injection of sclerosing agent for the treatment of lung bullae: its clinical application

CT-Guided Cervical Transforaminal Steroid Injections: Where Should the Needle Tip Be Located?

The aim of CT-guided CTSI is to inject medication into the foraminal region where the nerve root is inflamed. The optimal location for needle placement and therapeutic delivery, however, remain uncertain. The purpose of this study was to investigate how needle positioning and angle of approach impact the transforaminal distribution of injectate. We retrospectively reviewed fluoroscopic images from 90 CT-guided CTSI procedures for needle-tip location, needle angle, and contrast distribution. Needle-tip position was categorized as either foraminal zone, junctional, or extraforaminal. Distribution of contrast injected immediately before steroid administration was categorized as central epidural, intraforaminal, or extraforaminal in location. Needle-tip location and angle were correlated with contrast distribution. The needle tip was most commonly placed in the junctional position (36 cases, 40%), followed by foraminal (30 cases, 33%) and extraforaminal (24 cases, 27%) locations. Intraforaminal contrast distribution was highest when the needle location was foraminal (30/30, 100%) or junctional (35/36, 97%), compared with extraforaminal (7/24, 29%) (P value <.0001). There was no relationship between needle angle and contrast distribution. Needle-tip location at the outer edge of the neural foramen (junctional location) correlated well with intraforaminal distribution of contrast for CT-guided CTSI and compared favorably with injectate distribution following foraminal zone needle positioning. Junctional needle positioning may be preferred over the foraminal zone by some proceduralists. Extraforaminal needle positioning resulted in less favorable contrast distribution, which may significantly diminish the therapeutic efficacy of CTSI.

Radiation dose reduction in CT-guided sacroiliac joint injections to levels of pulsed fluoroscopy: a comparative study with technical considerations

BackgroundThe sacroiliac (SI) joint is frequently the primary source of low back pain. Over the past decades, a number of different SI injection techniques have been used in its diagnosis and therapy. Despite the concerns regarding exposure to radiation, image-guided injection techniques are the preferred method to achieve safe and precise intra-articular needle placement. The following study presents a comparison of radiation doses, calculated for fluoroscopy and CT-guided SI joint injections in standard and low-dose protocol and presents the technical possibility of CT-guidance with maximum radiation dose reduction to levels of fluoroscopic-guidance for a precise intra-articular injection technique.ObjectiveTo evaluate the possibility of dose reduction in CT-guided sacroiliac joint injections to pulsed-fluoroscopy-guidance levels and to compare the doses of pulsed-fluoroscopy-, CT-guidance, and low-dose CT-guidance for intra-articular SI joint injections.Study designComparative study with technical considerations.MethodsA total of 30 CT-guided intra-articular SI joint injections were performed in January 2012 in a developed low-dose mode and the radiation doses were calculated. They were compared to 30 pulsed-fluoroscopy-guided SI joint injections, which were performed in the month before, and to five injections, performed in standard CT-guided biopsy mode for spinal interventions. The statistical significance was calculated with the SPSS software using the Mann–Whitney U-Test. Technical details and anatomical considerations were provided.ResultsA significant dose reduction of average 94.01% was achieved using the low-dose protocol for CT-guided SI joint injections. The radiation dose could be approximated to pulsed-fluoroscopy- guidance levels.ConclusionRadiation dose of CT-guided SI joint injections can be decreased to levels of pulsed fluoroscopy with a precise intra-articular needle placement using the low-dose protocol. The technique is simple to perform, fast, and reproducible.

CT-guided intramuscular botulinum toxin A injections into the deep anterior neck muscles in patients with pure antecaput or antecollis

Aim of the studyTo demonstrate the influence of botulinum toxin (BTX) type A injections into the deep anterior neck muscles (aDNMs) on the severity of cervical dystonia (CD) in severely affected CD-patients with pure antecaput and/or antecollis. MethodsRetrospective analysis of our (Access) data bank and the CT-scans performed during injections.In eight patients CT-guided injections were performed. Outcome was measured by means of the TSUI-score and a 4 point global assessment scale (GAS) to score efficacy, tolerability and pain relief of BTX-A injections into the aDNMs. Patients were asked for side effects of the injections. ResultsRetrospective analysis reveals that CT-guided intramuscular injections of BTX-A into the aDNMs improve antecollis better than antecaput and reduce pain, but are tolerated barely. The most frequent side-effects were dysphagia and anxiety. The majority of patients wanted to be reinjected. ConclusionFor the special subgroup of CD-patients with a severe antecollis CT-guided injections of the aDNMs are a relevant treatment option for intermittent but not continuous intervention.

CT-Guided Transforaminal Epidural Injections with Local Anesthetic, Steroid, and Tramadol

CT-Guided Transforaminal Epidural Injections with Local Anesthetic, Steroid, and Tramadol