MR-guided perineural injection of the ganglion impar: technical considerations and feasibility

Marker, David R.; U-Thainual, Paweena; Ungi, Tamás; Flammang, Aaron; Fichtinger, Gabor; Iordachita, Iulian; Carrino, John A.; Fritz, Jan

doi:10.1007/s00256-016-2333-7

Cited by 15 publications

(7 citation statements)

References 42 publications

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“…Imaging guidance can include fluoroscopy and more recently CT, ultrasonography, and MR imaging guidance [11][12][13]. A fluoroscopic-guided transsacrococcygeal approach is much preferred by clinicians in comparison to a conventional anatomical technique, as it is technically more feasible and has a lower risk of visceral injuries [14].…”

Section: Discussionmentioning

confidence: 99%

Conus infarction after non-guided transcoccygeal ganglion impar block using particulate steroid for chronic coccydynia

Kuek

Chung

Zishan

et al. 2019

Spinal Cord Ser Cases

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Introduction Ganglion impar block (GIB) is a well-recognised treatment for chronic coccydynia. Several side effects have previously been described with this procedure, including transient motor dysfunction, bowel, bladder, and sexual dysfunction, neuritis, rectal perforation, impingement of the sciatic nerve, cauda equina syndrome, and infection. Case presentation We describe the first report of imaging-documented conus infarction after an unguided-GIB performed in theatre using particulate steroids for a 17-year-old patient with coccydynia. Immediately post-GIB, patient developed transient neurological deficits in her lower limbs of inability to mobilise her legs that lasted for 24 h. These include back and leg pain, decreased power and movement, increased tone, brisk reflexes, reduced light touch sensation and proprioception of legs up to the T10 level. Urgent MRI spine showed intramedullary hyperintense signal within the conus and mild restricted diffusion on the distal cord and conus, suggestive of an acute conus infarction. On follow-up, the GIB did not result in symptom improvement of coccydynia and there was persistent altered sensation of her legs. Discussion Various approaches of ganglion impar block have been described and performed in the past with different imaging techniques and injectants. A few cases of unusual neurological complications have been reported with the use of epidural steroid injections and ganglion impar block. Clinicians should be aware of the possible neurological complications following ganglion impar blocks and the risk of inadvertent intravascular injection of particulate steroids can potentially to be minimised by using imaging guidance.

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Section: Discussionmentioning

confidence: 99%

Conus infarction after non-guided transcoccygeal ganglion impar block using particulate steroid for chronic coccydynia

Kuek

Chung

Zishan

et al. 2019

Spinal Cord Ser Cases

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“…47 MRI-guided procedures are advantageous over fluoroscopy or CT for multifocal and serial procedures in the same area, 25,48 young patients where the procedures are performed near radiation-sensitive organs, 15 lesions that are only visible on MRI, and for structures with frequently occurring anatomical variants, such as peripheral sensory nerves and paraspinal ganglia. 49 Interventional MRI parallels ultrasonography in its benefits of nonionizing radiation properties 35,41,50 and further permits the combination with preprocedural and postprocedural diagnostic MRI to identify targets and document the postprocedural appearance 49 of targeted lesions for comparison with further follow-up imaging.…”

Section: Magnetic Resonance Imagingmentioning

confidence: 99%

Image-guided Sports Medicine and Musculoskeletal Tumor Interventions: A Patient-Centered Model

Dalili

Isaac

Rashidi

et al. 2020

Semin Musculoskelet Radiol

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The spectrum of effective musculoskeletal (MSK) interventions is broadening and rapidly evolving. Increasing demands incite a perpetual need to optimize services and interventions by maximizing the diagnostic and therapeutic yield, reducing exposure to ionizing radiation, increasing cost efficiency, as well as identifying and promoting effective procedures to excel in patient satisfaction ratings and outcomes. MSK interventions for the treatment of oncological conditions, and conditions related to sports injury can be performed with different imaging modalities; however, there is usually one optimal image guidance modality for each procedure and individual patient. We describe our patient-centered workflow as a model of care that incorporates state-of-the-art imaging techniques, up-to-date evidence, and value-based practices with the intent of optimizing procedural success and outcomes at a patient-specific level. This model contrasts interventionalist- and imaging modality-centered practices, where procedures are performed based on local preference and selective availability of imaging modality or interventionalists. We discuss rationales, benefits, and limitations of fluoroscopy, ultrasound, computed tomography, and magnetic resonance imaging procedure guidance for a broad range of image-guided MSK interventions to diagnose and treat sports and tumor-related conditions.

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“…Blocking the Ganglion Impar attenuates this sympathetically mediated recalcitrant chronic pelvic pain, leading to reduction of opioids consumption, less side effects and an improvement in the patients' quality of life. 4 A radiofrequency ablation is a minimally invasive procedure that destroys the nerve fibers carrying pain signals to the brain.Radiofrequency ablation (RFA) of Ganglion Impar is a well-established, drug-free treatment that has been clinically proven to provide safe, effective, lasting relief from chronic pain. Both TRF(Thermal radiofrequency ablation) and PRF(Pulsed radiofrequency ablation) treatment induce distancedependent tissue destruction under the stimulating needle.…”

Section: Introductionmentioning

confidence: 99%

Comparison of Visual Analog Scale (VAS) between Pulsed and Thermal Radiofrequency Ablation of Ganglion Impar in Patients of Chronic Pelvic Pain

Verma¹,

Syal²,

Verma³

et al. 2022

IARJACC

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The present study was done to compare theVisual Analog Scale (VAS) score between Thermal and Pulsed radiofrequency ablation in Ganglion Impar block for treatment of chronic pelvic pain in female patients. Material and Methods: The present study was prospective, randomized, single blinded study and was based on series of 30 patients presenting with chronic pelvic pain, having already failed conservative medical management, presenting in Pain clinic if IGMC Shimla. The patients were divided into 2 groups of 15 patients. Patients in Group A(n=15) were given thermal radiofrequency ablation where as patients in Group B were given pulsed radiofrequency ablation.Results: Mean Pre-procedural VAS score of the patients in Group A was 7.93 ± 0.704 where as mean Pre-procedure VAS score in patients of group B was 8.00 ± 0.655.( P =0.790).Mean 24 Hours Post Procedural VAS Score of the patients in Group A was 2.53 ± 0.516 where as mean 24 Hours Post Procedural VAS Score in patients of group B was 3.53 ± 0.640.( P= 0.000). Mean 1 week Post Procedural VAS Score of the patients in Group A was 2.60 ± 0.507 where as mean 1 week Post Procedural VAS Score in patients of group B was 3.40 ± 0.507. (P= 0.000) Mean 2 week Post Procedural VAS Score of the patients in Group A was 2.33 ± 0.507 where as mean 2 week Post Procedural VAS Score in patients of group B was 3.31 ± 0.564. (P=0.000) .Mean 3 week Post Procedural VAS Score of the patients in Group A was 2.31 ± 0.415 where as mean 3 week Post Procedural VAS Score in patients of group B was 3.29 ± 0.516.( P =0.000). Conclusion: Present study showed that mean Post Procedural VAS Score(24 Hours, 1,2 and 3 week) was significantly lower in group A as compared to group B. we can conclude that thermal radiofrequency ablation of ganglion impar for chronic pelvic pain produces prolonged pain free period in the patients as compared to patients who were treated with pulsed radio frequency ablation.

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MR-guided perineural injection of the ganglion impar: technical considerations and feasibility

Abstract: Interventional MRI can visualize and directly target the ganglion impar for accurate needle placement and successful periganglionic injection with the additional benefit of no ionizing radiation exposure to patient and staff. Our results support clinical evaluation.

Cited by 15 publications

References 42 publications

Conus infarction after non-guided transcoccygeal ganglion impar block using particulate steroid for chronic coccydynia

Conus infarction after non-guided transcoccygeal ganglion impar block using particulate steroid for chronic coccydynia

Image-guided Sports Medicine and Musculoskeletal Tumor Interventions: A Patient-Centered Model

Comparison of Visual Analog Scale (VAS) between Pulsed and Thermal Radiofrequency Ablation of Ganglion Impar in Patients of Chronic Pelvic Pain

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