Magnetic Resonance (MR)-guided Percutaneous Pain Therapy of Degenerative Spinal Diseases

Abstract

Computed Tomography (CT)-guided local injections offer a precise deposition of the medication within the region of the irritated sciatic nerve. To eliminate unnecessary radiation and to increase imaging capabilities, we have evaluated the feasibility of magnetic resonance (MR)-guided therapy of back pain and sciatica as well as MR-guided lumbar sympathectomy. The technique of MR-guided injection and MR-compatible cannulae have been developed and tested by using ex vivo specimens of the spine and an animal model. We treated 161 patients, ages 20 to 86 years (mean 51.5 years), 83 female and 78 male, with MR-guided periradicular injections up to five times (mean 2.3) every 3 to 4 weeks at levels C5/6, C6/7, L3/4, L4/5, and L5/S1, facet joint neurolysis at levels L4/5 and L5/S15, and infiltrations of the sacroiliac joints; 16 patients underwent chemical lumbar sympathectomy. All procedures were performed successfully. Improvements of symptoms such as reduction of pain of about 80% were noted in 70% of our patients; 16 (10%) patients required other treatments. Despite moderate pain, no complications, such as bleeding or infection, occurred. We demonstrated that MR-guided lumbar pain therapy in a 0.2-tesla horizontal open magnet is feasible. The early clinical results are comparable to CT-guided pain therapy, but further technical improvements of the MR technology is required.

Keywords:

Interventional MR - peridural and epidural corticoid injection - MR guidance - sciatic pain - facet joints