Rachis interventionnel

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• 作者：Mario Muto¹ ; ^{mutomar@tiscali.it" class="auth_mail" title="E-mail the corresponding author} ; Francesco Giurazza² ; Mario Tecame³ ; Gianluigi Guarnieri¹
• 关键词：Spine ; Oxygen-ozone nucleolysis ; Facet joint ablation ; Vertebroplasty ; Assisted technique
• 刊名：Journal of Neuroradiology
• 出版年：2016
• 出版时间：March 2016
• 年：2016
• 卷：43
• 期：2
• 页码：68-69
• 全文大小：591 K

文摘

In the last two decades, several percutaneous mini-invasive techniques have been developed in the field of interventional radiology related to the wide spectrum of spine pathology diseases: degenerative, traumatic and oncological. Oxygen-ozone nucleolysis, facet joint ablation and vertebral cementoplasty are well-known mini-invasive treatments to obtain pain relief in patients affected by radicular conflicts, vertebral porotic fractures, primary or secondary spine lesions and spine trauma.

Oxygen-ozone nucleolysis is a safe and cost-effective approach to patients with sciatica refractive to conservative therapy, having demonstrated good short and long-term results; it is performed CT or fluoro-guided through a 20–22 gauge needle and gas mixture is often combined with periradicular administration of steroids and local anesthesia. Disc access is gained with a posterolateral extrapedicular approach on the symptomatic side at the lesion-disc level. The needle position is confirmed in the center of the disc by fluoroscopy (Fig. 1A and B) or CT images (Fig. 2A and B), considering the ideal needle position at the junction between the posterior and the middle third of the disc. When the posterolateral approach at L5–S1 level is unfeasible because of a narrow angle due to iliac crests, a translaminar approach can be considered.

Facet joint ablation through thermal ablation of the medial branch nerves that innervate the facet joints is an interventional well-established treatment modality of axial low back pain. Facet joint pain has been estimated to account for as many as 30% of chronic low back pain cases. Nociceptive sensation in the facet joints is carried by afferent fibers in the medial branch nerves of the lumbar dorsal rami. Lesioning these structures by thermal (radiofrequency or cryo) is commonly used as a treatment for facet-mediated low back pain. These techniques have been shown to provide significant improvement in function, pain, and analgesic use for 6–12 months in individuals with facet-mediated chronic low back pain.

Vertebral cementoplasty is a well-known mini-invasive treatment to obtain pain relief in patients affected by vertebral porotic fractures, primary or secondary spine lesions and spine trauma through intrametameric cement injection. Two major categories of treatment are included within the term vertebral cementoplasty: the first is vertebroplasty in which a simple cement injection in the vertebral body is performed (Fig. 3); the second is assisted technique in which a device is positioned inside the metamer before the cement injection to restore vertebral height and allow a better cement distribution, reducing the kyphotic deformity of the spine, trying to obtain an almost normal spine biomechanics (Fig. 4).

Aim of this presentation is to describe the most advanced techniques and indications of those procedures.