CT-guided infiltration saves surgical intervention and fastens return to work compared to anatomical landmark-guided infiltration in patients with lumbosciatica

Deml, Moritz C.; Buhr, M; Wimmer, Matthias; Pflugmacher, Robert; Riedel, Rainer; Rommelspacher, Yorck; Kabir, K.

doi:10.1007/s00590-015-1602-9

Cited by 12 publications

(4 citation statements)

References 21 publications

(34 reference statements)

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“…Die biologische Defektaugmentation mit z. B. allogener Spongiosa liefert bei kleineren ossären Defekten sowohl am Becken als auch am Femur vielversprechende Ergebnisse [10][11][12]23]. Ein Restrisiko für eine Infektion besteht jedoch trotz Sterilisationsverfahren mittels Bestrahlung weiterhin.…”

Section: Diskussionunclassified

Tumorprothesen in der endoprothetischen Revisionschirurgie der unteren Extremität – Ergebnisse von 25 Patienten nach Versorgung mit einem modularen Tumor- und Revisionssystem (MUTARS®)

et al. 2016

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With extended life expectancy, the number of primary joint arthroplasties has also increased. Revision surgery is also more often necessary, due to aseptic or septic loosening of the prosthesis or periprosthetic fracture. Large bone defects often occur in these patients and several non-modular, conventional implants are available to handle this difficult situation. Custom made implants offer an individually designed and defect-adapted shape with perfect covering of the lesion, but may delay the operation. The Modular Universal Tumor And Revision System (MUTARS®) offers the possibility to vary the length and angle of the femoral neck and the antetorsion angle. Thus, it permits intraoperative adaption to the individual patient's defect. The aim of our study is to present clinical, functional results and the rate of complications in a cohort of patients undergoing revision surgery for failed endoprosthetic replacement or failed trauma surgery, using the Modular Universal Tumor And Revision System with short-to midterm follow-up. Between August 2005 and September 2014, 25 patients (17 female, 8 male) with an average age of 72 years (min. 56, max. 92 years) were included in a retrospective study using the MUTARS® system. The patients underwent surgical revision of osseous defects that were not susceptible to conventional care. The mean follow-up was 16 months (min. 12, max. 72 months). The indications which led to revision surgery were as follows: loosened metal-on-metal prosthesis with an acetabular defect caused by a metal-induced granuloma (n = 1), pseudoarthrosis after implantation of femur nail (n = 2), cut-out of a femur nail (n = 1), aseptic loosening of an implanted endoprosthesis (n = 4), septic loosening of an implanted endoprosthesis (n = 1), periprosthetic fracture (n = 6) and periprosthetic infection after two stage revision surgery (infection consolidated Girdlestone situation) (n = 10). All patients were followed up at regular intervals, both clinically and radiologically. Apart from comorbidities, clinical and functional parameters were measured, including the Harris Hip Score. An outcome analysis was also performed with respect to peri- and postoperative complications. Serial plain X-rays were followed-up. In all patients, stable reconstruction without the use of an allograft was possible. In total, 23 patients underwent surgery by using a proximal femur prosthesis; three patients also received a custom made acetabular component. One patient was treated by using a distal femur and one patient was treated by implantation of a total femur prosthesis. The average length of hospital stay was 25 days (min.11, max. 47 days). The Harris Hip Score improved from 28 points preoperatively to 81 points after surgery.In total we recorded 24 % of complications after surgery. Two patients suffered recurrent periprosthetic infection and the prosthesis had to be revised in a further two stage exchange; one patient had a tractus gap and was revised by surgery. Two patients suffered periprosthetic fracture due to trauma...

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Section: Diskussionunclassified

Tumorprothesen in der endoprothetischen Revisionschirurgie der unteren Extremität – Ergebnisse von 25 Patienten nach Versorgung mit einem modularen Tumor- und Revisionssystem (MUTARS®)

et al. 2016

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“…Specifically, multi-detector CT (MDCT) is often used, allowing for initial procedure planning and subsequent surveillance of the procedure. Compared to non-navigated approaches, using interventional CT scanning has shown not only to improve safety as well as precision and pain reduction, but also to reduce the overall treatment duration for periradicular infiltrations 12 , 13 . Furthermore, interventional procedures at the spine under CT guidance afford the interventionalist several advantages over conventional fluoroscopic methods, as the interventionalist has a direct visualization of the needle tip to target soft tissues during the whole procedure as well as a superior contrast resolution and an improved ability to navigate in case of difficult anatomical situations, such as severe osseous stenosis 14 .…”

Section: Introductionmentioning

confidence: 99%

Low-dose multi-detector computed tomography for periradicular infiltrations at the cervical and lumbar spine

Paprottka

Kupfer

Schultz

et al. 2022

Sci Rep

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Periradicular infiltrations are frequently performed in daily neuroradiological routine and are often guided by multi-detector computed tomography (MDCT), thus leading to radiation exposure. The purpose of this study was to evaluate MDCT with low dose (LD) and model-based iterative reconstruction for image-guided periradicular infiltrations at the cervical and lumbosacral spine. We retrospectively analyzed 204 MDCT scans acquired for the purpose of cervical or lumbosacral periradicular interventions, which were either derived from scanning with standard dose (SD; 40 mA and 120 kVp) or LD (20–30 mA and 120 kVp) using a 128-slice MDCT scanner. The SD cases were matched to the LD cases considering sex, age, level of infiltration, presence of spinal instrumentation, and body diameter. All images were reconstructed using model-based iterative image reconstruction and were evaluated by two readers (R1 and R2) using 5- or 3-point Likert scales (score of 1 reflects the best value per category). Furthermore, noise in imaging data was quantitatively measured by the standard deviation (StDev) of muscle tissue. The dose length product (DLP) was statistically significantly lower for LD scans (6.75 ± 6.43 mGy*cm vs. 10.16 ± 7.70 mGy*cm; p < 0.01; reduction of 33.5%). Image noise was comparable between LD and SD scans (13.13 ± 3.66 HU vs. 13.37 ± 4.08 HU; p = 0.85). Overall image quality was scored as good to very good with only minimal artifacts according to both readers, and determination of the nerve root was possible in almost all patients (LD vs. SD: p > 0.05 for all items). This resulted in high confidence for intervention planning as well as periprocedural intervention guidance for both SD and LD scans. The inter-reader agreement was at least substantial (weighted Cohen’s κ ≥ 0.62), except for confidence in intervention planning for LD scans (κ = 0.49). In conclusion, considerable dose reduction for planning and performing periradicular infiltrations with MDCT using model-based iterative image reconstruction is feasible and can be performed without clinically relevant drawbacks regarding image quality or confidence for planning.

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“…In a study between ct-assisted and anatomical landmark-guided injection, Demel et al showed that ct-assisted periradicular injection resulted in a higher accuracy of needle position with better pain reduction. Major complications did not appear in both groups [ 21 ]. Kamp et al could not find any complications in a study of ct-assisted vs fluoroscopy-assisted transforaminal epidural steroid injection for lumbar radiculopathy in 116 patients [ 22 ].…”

Section: Discussionmentioning

confidence: 99%

Complications of injections in conservative treatment of degenerative spine disease: a prospective unicentric study

Voelker

Pirlich

Heyde

2022

BMC Musculoskelet Disord

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Background Spinal injection has been an accepted part of conservative therapy for degenerative diseases. The drugs used can cause side effects and severe complications. The aim of this study was to determine the occurrence of general side effects (GSE) and complications when performing consecutive different types of spinal injections and to evaluate pain reduction. Methods Prospective data evaluation of patients with degenerative spine disease at hospital admission, discharge, and six and 12 weeks after discharge. All patients received a specific injection protocol depending on their symptoms and radiological findings. The injections performed were dorsal sacroiliac joint injections, perineural injections, epidural interlaminar and epidural periradicular injections, and facet joint injections. Potential complications were categorized and recorded as GSE and complications. In addition, the Numerical Analog Scale (NAS) for pain, the Oswestry Disability Index (ODI) were evaluated. Results Forty-eight patients were enrolled. There were 282 spinal injections performed. A total of 131 common treatment-related events were recorded. Depending on the type of injection, transient pain at the injection site (32.4–73.5%), radiating pain (9.4–34.7%), and nerve root irritation (2–18.4%) were the most common. One complication with postpuncture syndrome occurred with epidural-interlaminar injection. No persistent neurologic deficits occurred. The highest rate of GSE was observed with periradicular injections (relative frequency (RF) = 0.8), followed by epidural-interlaminar injections (RF = 0.65), least frequently with FJ injections (RF = 0.32). From the time of admission to discharge, NAS scores were significantly decreased and ODI score significantly improved at discharge (p < 0.001), but relapse occurred at the 12-week follow-up. Conclusions Various consecutive spinal injections for conservative treatment of degenerative spine diseases are safe and lead to a decrease in pain and improvement in quality of life. GSE are common, but not persistent. Although complications are rare, they can have serious consequences for the patient.

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CT-guided infiltration saves surgical intervention and fastens return to work compared to anatomical landmark-guided infiltration in patients with lumbosciatica

Cited by 12 publications

References 21 publications

Tumorprothesen in der endoprothetischen Revisionschirurgie der unteren Extremität – Ergebnisse von 25 Patienten nach Versorgung mit einem modularen Tumor- und Revisionssystem (MUTARS®)

Tumorprothesen in der endoprothetischen Revisionschirurgie der unteren Extremität – Ergebnisse von 25 Patienten nach Versorgung mit einem modularen Tumor- und Revisionssystem (MUTARS®)

Low-dose multi-detector computed tomography for periradicular infiltrations at the cervical and lumbar spine

Complications of injections in conservative treatment of degenerative spine disease: a prospective unicentric study

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