New treatment for Spine Pain-2017

Presentation at MALAYSIA-K L East Asia Pain Meeting Jan 2017

- Fluoroscopic vs CT Guided Cervical and Lumbar Spondylotic pain intervention procedures

Introduction

Cervical and Lumbar spondylotic pain intervention procedures are effective to alleviate pain in degenerative spine disease. Intervention includes: facet joint/transforaminal nerve blocks and steroid injections, radiofrequency ablation(RFA) of medial branch sensory nerves. Co-blation procedures like lumbar nucleoplasty can also be performed. Procedures can be performed with Intra-Operative fluoroscopic guidance or Computerised Tomographic(CT) Scan guidance in the Radiology Suite.

Introduction

Cervical and Lumbar spondylotic pain intervention procedures are effective to alleviate pain in degenerative spine disease. Intervention includes: facet joint/transforaminal nerve blocks and steroid injections, radiofrequency ablation(RFA) of medial branch sensory nerves. Co-blation procedures like lumbar nucleoplasty can also be performed. Procedures can be performed with Intra-Operative fluoroscopic guidance or Computerised Tomographic(CT) Scan guidance in the Radiology Suite.

Method

This was a single spine surgeon retrospective study. From November 2014 to November 2015, the author performed procedures in CT radiology suite, and from December 2015 onwards with intra-operative fluoroscopic guidance in theatre

--L5-S1 Nucleoplasty Procedure(Fluoroscopic guided)

---C4-5 facet joint steroid injections

Results

Thirty two(32) patients had 33 cervical and lumbar percutaneous pain injection procedures(13 cervical, 20 lumbar). Including: 10 lumbar nucleoplasty co-blations, and 16 radiofrequency ablations(RFA) of medial sensory branch nerves. Average age was 46 years, 13 patients were female, 19 were male. Thirteen(13) procedures were performed in the CT suite, and 20 in operating theatre under fluoroscopic guidance.

Overall results in both groups were good. In the fluoro group, the average Visual Analogue Scale(VAS) decreased from 8(pre-intervention) to 1(3 months post-intervention). In the CT group, the VAS decreased from 8(pre-intervention) to 1(3 months post-intervention). There were no cases of limb weakness or nerve damage post-procedure in both groups.

In the fluoro group, 1 patient had transient leg numbness, which improved subsequently. Three(3) patients in the CT group had partial recurrence of pain after 3 months. There were no cases of infection or discitis.

Conclusion

Fluoroscopic guided pain intervention injection procedures are as effective as CT guided ones. Overall improvement in pain scores(VAS) are good, with low complication rates.

Reference:

(1)A Systematic Review of Therapeutic Facet Joint Interventions in Chronic Spinal Pain. Manohar Lal Sharma et al. Pain Physician July 2015(18) E535-582.