CT-guided Interventional Therapy of Back Pain – Predictors of Success in TreatmentArticle in several languages: English | deutsch
Purpose The aim of the presented study was to investigate if distribution of the drug-contrast medium mixture in CT-guided periradicular therapy can predict intervention success.
Materials and Methods Over a 15-month period, 97 patients admitted to our institution by a pain physician for CT guided periradicular therapy were treated. In 420 CT guided interventions, we measured the relative distribution of the drug mixture in relationship to the neuroforamen. The distribution was correlated to the patient’s pain score over time. In addition, dependence of success in treatment with regards to the treating physician was evaluated.
Results Ninety percent of the patients experienced a decrease of pain score under therapy, only 10 % showed no change. On average there was an improvement in pain score from 7.4 (2–10) before therapy to 3.7 (0–9) at the end of therapy. We observed a weak correlation of –0.22 (p < 0.028) between distribution of drug mixture to the neuroforamen and reduction of pain score. The therapy outcome displayed a dependency regarding the treating physician (p < 0.0084).
Conclusion CT guided periradicular therapy offers good pain reduction in most of the patients. Drug distribution near the affected nerve and treating physician are factors for clinical success.
CT-guided periradicular therapy shows a good or very good improvement in the symptoms in 90 % of the treated patients.
In addition to technical performance, the treating radiologist is an important parameter determining success.
The success of CT-guided treatment is only moderately correlated with an absolute distribution of the drug mixture.
Stueckle CA, Talarczyk S, Hackert B et al. CT-guided Interventional Therapy of Back Pain – Predictors of Success in Treatment. Fortschr Röntgenstr 2020; DOI: 10.1055/a-1161-9358
Received: 01 February 2020
Accepted: 11 April 2020
16 July 2020 (online)
© Georg Thieme Verlag KG
Stuttgart · New York
- 1 Manchikanti L, Singh V, Falco FJ. et al Epidemiology of low back pain in adults. Neuromodulation: journal of the International Neuromodulation Society 2014; 17 (Suppl. 23) 10
- 2 Geneen LJ, Moore RA, Clarke C. et al Physical activity and exercise for chronic pain in adults: an overview of Cochrane Reviews. The Cochrane database of systematic reviews 2017; 4CD011279
- 3 Kuijpers T, van Middelkoop M, Rubinstein SM. et al A systematic review on the effectiveness of pharmacological interventions for chronic non-specific low-back pain. European spine journal: official publication of the European Spine Society, the European Spinal Deformity Society, and the European Section of the Cervical Spine Research Society 2011; 20: 40-50
- 4 Breivik H, Eisenberg E, O’Brien T. et al The individual and societal burden of chronic pain in Europe: the case for strategic prioritisation and action to improve knowledge and availability of appropriate care. BMC public health 2013; 131229
- 5 Hoy D, Brooks P, Blyth F. et al The Epidemiology of low back pain. Best practice & research Clinical rheumatology 2010; 24: 769-781
- 6 Jacobs WC, van Tulder M, Arts M. et al Surgery versus conservative management of sciatica due to a lumbar herniated disc: a systematic review. European spine journal: official publication of the European Spine Society, the European Spinal Deformity Society, and the European Section of the Cervical Spine Research Society 2011; 20: 513-522
- 7 Manchikanti L, Singh V, Cash KA. et al Effect of fluoroscopically guided caudal epidural steroid or local anesthetic injections in the treatment of lumbar disc herniation and radiculitis: a randomized, controlled, double blind trial with a two-year follow-up. Pain physician 2012; 15: 273-286
- 8 Lee JW, Kim SH, Choi JY. et al Transforaminal epidural steroid injection for lumbosacral radiculopathy: preganglionic versus conventional approach. Korean journal of radiology 2006; 7: 139-144
- 9 Waggershauser T, Schwarzkopf S, Reiser M. Facet blockade, peridural and periradicular pain therapy. Der Radiologe 2006; 46: 520-526 . Facettenblockade, peridurale und periradikulare Schmerztherapie
- 10 Buttermann GR. Treatment of lumbar disc herniation: epidural steroid injection compared with discectomy. A prospective, randomized study. The Journal of bone and joint surgery American volume 2004; 86-A: 670-679
- 11 Kaye AD, Manchikanti L, Abdi S. et al Efficacy of Epidural Injections in Managing Chronic Spinal Pain: A Best Evidence Synthesis. Pain physician 2015; 18: E939-E1004
- 12 Manchikanti L, Knezevic NN, Boswell MV. et al Epidural Injections for Lumbar Radiculopathy and Spinal Stenosis: A Comparative Systematic Review and Meta-Analysis. Pain physician 2016; 19: E365-E410
- 13 Wewalka M, Abdelrahimsai A, Wiesinger GF. et al CT-guided transforaminal epidural injections with local anesthetic, steroid, and tramadol for the treatment of persistent lumbar radicular pain. Pain physician 2012; 15: 153-159
- 14 Maurer MH, Schreiter N, de Bucourt M. et al Cost comparison of nerve root infiltration of the lumbar spine under MRI and CT guidance. European radiology 2013; 23: 1487-1494
- 15 Manchikanti L, Pampati V, Benyamin RM. et al Cost Utility Analysis of Lumbar Interlaminar Epidural Injections in the Treatment of Lumbar Disc Herniation, Central Spinal Stenosis, and Axial or Discogenic Low Back Pain. Pain physician 2017; 20: 219-228
- 16 Lee JH, Shin KH, Bahk SJ. et al Comparison of clinical efficacy of transforaminal and caudal epidural steroid injection in lumbar and lumbosacral disc herniation: A systematic review and meta-analysis. The spine journal: official journal of the North American Spine Society 2018
- 17 Thomas E, Cyteval C, Abiad L. et al Efficacy of transforaminal versus interspinous corticosteroid injectionin discal radiculalgia – a prospective, randomised, double-blind study. Clinical rheumatology 2003; 22: 299-304
- 18 Yang SC, Fu TS, Lai PL. et al Transforaminal epidural steroid injection for discectomy candidates: an outcome study with a minimum of two-year follow-up. Chang Gung medical journal 2006; 29: 93-99
- 19 Teske W, Zirke S, Nottenkamper J. et al Anatomical and surgical study of volume determination of the anterolateral epidural space nerve root L5 / S1 under the aspect of epidural perineural injection in minimal invasive treatment of lumbar nerve root compression. European spine journal: official publication of the European Spine Society, the European Spinal Deformity Society, and the European Section of the Cervical Spine Research Society 2011; 20: 537-541
- 20 Vad VB, Bhat AL, Lutz GE. et al Transforaminal epidural steroid injections in lumbosacral radiculopathy: a prospective randomized study. Spine 2002; 27: 11-16
- 21 McIver TA, Kornelsen J, Stroman PW. Diversity in the emotional modulation of pain perception: An account of individual variability. European journal of pain 2018; 22: 319-332
- 22 Lavin R, Park J. A characterization of pain in racially and ethnically diverse older adults: a review of the literature. Journal of applied gerontology: the official journal of the Southern Gerontological Society 2014; 33: 258-290
- 23 Park J, Newman D, Engstrom G. et al The moderating and covarying effects of social support and pain intensity on depressive symptomology among racially and ethnically diverse older adults. Pain management 2017; 7: 19-32
- 24 Yu RK, Lagemann GM, Ghodadra A. et al Extraforaminal needle tip position reduces risk of intravascular injection in CT-fluoroscopic lumbar transforaminal epidural steroid injections. Journal of spine surgery 2016; 2: 246-255