Image-Guided Spine Interventions (eBook)

Anchor 1 5
Anchor 2 8
1 10
Spine Anatomy 10
Introduction 10
Physical Components 10
Bones 10
Intervertebral Discs and Joints 17
Spinal Nerves 20
Anatomical Spaces 23
Vascular Anatomy of the Spinal Cord 24
Macrocirculation 24
Radicular Arteries 27
Radiculopial Arteries 27
Radiculomedullary Arteries 27
Microcirculation 28
Centrifugal System 28
Centripetal System 30
Somatic Arterial Supply 31
Angiography 31
Spinal Venous Anatomy 31
References 35
2 37
Materials Used in Image-Guided Spine Interventions 37
Imaging Equipment 37
Pharmacological Agents for Spine Intervention 40
Corticosteroids 40
Anesthetic Agents 41
Antibiotics 42
Analgesics 43
Adjuvant Analgesics 44
Radiographic Contrast Agents 44
Neurolytic (Cytotoxic) Agents 45
References 45
3 47
Patient Evaluation and Criteria for Procedure Selection 47
Introduction 47
History and Physical Examination 50
History Gathering 50
Physical Examination 51
Imaging Studies 52
Conventional Radiographs 52
Myelography 53
Computed Tomography Scanning 53
Magnetic Resonance Imaging 53
Ultrasound 54
Bone Scanning 54
Thermography 55
Electrodiagnostics 55
Electromyography 55
Nerve Conduction Studies 56
Laboratory Tests 56
Diagnostic Nerve Blocks 56
Peripheral Nerve Blocks 57
Central Nerve Blocks 58
Psychological Evaluation 58
Criteria for Procedure Selection 59
Conclusion 63
References 63
4 64
The Surgeon’s Perspective: Image-Guided Therapy and Its Relationship to Conventional Surgical Management 64
Introduction 64
Discography 65
Facet Blockade 68
Sacroiliac Joint (SI) Injections 69
Selective Nerve Root Blockade 70
Epidural Steroid Injections 71
Minimally Invasive Intradiscal Therapy 72
Vertebroplasty and Kyphoplasty 73
Conclusion 75
References 75
5 81
Image-Guided Percutaneous Spine Biopsy 81
Introduction 81
Patient Preparation 84
Equipment Requirements 85
Biopsy Techniques 87
Soft Tissue Biopsy 104
Postoperative Care 107
Conclusion 107
References 111
6 113
Discography 113
Introduction 113
Box 6.1 114
Indications 114
Complications 114
Box 6.2. Intradiscal antibiotics 115
Conscious Sedation 115
Discogram Reporting 116
Lumbar Discography 116
Anatomy 117
Procedure 118
Postprocedure Care 126
Manometry 127
Functional Anesthetic Discography 128
Lumbar Discography in Surgical Outcomes 130
Thoracic Discography 130
Anatomy 131
Procedure 131
Postprocedure Care 136
Cervical Discography 136
Anatomy 137
Procedure 137
Anterior Paratracheal Approach 140
Oblique Approach 141
Postprocedure Care 144
Cervical Discography for Surgical Planning 145
Importance of Strict Discography Criteria 145
Vertebrogenic Pain 147
Conclusion 147
References 148
7 153
Percutaneous Lumbar Discectomy 153
Introduction 153
Anatomy 153
Intervertebral Discs in Spinal Pain 155
Historical Perspective 155
Indications and Procedure Needle Placement 156
Complications and Consent 158
Conclusion 160
References 160
8 162
Epidural Injections for the Treatment of Spine-Related Pain Syndromes 162
Introduction 162
Historical Perspectives 162
Demographics 163
Patient Selection 163
Coagulation and Epidural Injections 164
Contraindications 166
Use of Fluoroscopic Guidance 166
Epidural Techniques 167
Intralaminar 167
Caudal 168
Catheter Techniques 169
Transforaminal 171
Cervical 171
Lumbar 173
Procedure 173
Selective Nerve Root Blocks 175
Conclusion 176
References 177
9 180
Pulsed Radiofrequency Procedures in Clinical Practice 180
Introduction 180
Key Points 182
The Dorsal Root Ganglion Procedure 182
Introduction 182
Key Points 184
History of Pulsed Radiofrequency Lesioning 184
Key Points 185
Mechanism of Action 185
Key Points 187
Anatomy 187
Key Points 189
Indications 189
Contraindications3,13 190
Absolute 190
Relative 190
Equipment and Drugs 190
History Reported by the Patient 191
Physical Exam 191
Laboratory 191
Pre-Operative Medication 191
Procedure 192
Positioning 192
Technique 193
DRG-RF 193
Post Treatment Patient Advice 196
Complications 196
Efficacy 200
Author’s Opinion 201
Billing 202
Peripheral Nerve PRF Procedures 202
Typical Peripheral PRF Procedures 203
Suprascapular Nerve Treatment Using Radiofrequency Aided by Fluoroscopy 203
Anatomy 203
Indications 204
Technique 204
Treatment of Post Surgical Pain after Inguinal Herniorrhaphy using Surface Landmarks 204
Introduction 204
Indications 206
Diagnosis 206
Anatomy 206
Technique 206
Complications and Efficacy of Peripheral Nerve PRF 206
Summary 207
References 207
10 211
Facet Joint Injections and Sacroiliac Joint Injections 211
Introduction 211
Facet Joint Injections 211
Background 211
Anatomy 212
Lumbar Facet Joints 213
Cervical Facet Joints 214
Thoracic Facet Joints 217
Diagnostic Criteria 217
Lumbar Facet Pain 217
Cervical Facet Pain 217
Injection Techniques 217
Lumbar Intra-articular Injection 220
Method 221
Lumbar Periarticular Injection 221
Lumbar Medial Branch Block 221
Method (Figure 10.8) 221
Cervical Facet Block 222
Method 223
Lateral Approach 223
Posterolateral Approach 223
Thoracic Facet Block 223
Method 224
Conclusion for Facet Joint Injections 224
Sacroiliac Joint Injections 224
Background 224
Anatomy 224
Innervation 225
Presentation 226
Diagnosis 226
Injection Technique 230
Conclusion for Sacroiliac Joint Injections 230
References 231
11 233
Autonomic Nerve Blockade 233
Introduction 233
Common Sympathetic Blockades 234
Stellate Ganglion Blockade 234
Indications 234
Injection Technique 234
Radiofrequency-Induced Blockade 236
Side Effects and Complications 236
Key Points 237
Thoracic and Splanchnic Sympathetic Blockades 237
Indications 237
Injection Technique 237
Radiofrequency Block Technique: Splanchnic Nerve Denervation (Retrocrural Approach) 239
Side Effects and Complications 239
Celiac Plexus Blockade 239
Indications 240
Injection Technique 240
Lumbar Sympathetic Blockade 243
Indications 243
Injection Technique 243
Radiofrequency Block Technique 243
Hypogastric Plexus Blockade 247
Indications 247
Injection Technique 247
Impar Ganglion Blockade 247
Indications 247
Injection Technique 247
Conclusion 250
References 250
12 252
Percutaneous Vertebroplasty 252
Introduction 252
Patient Selection and Workup 253
Cement Selection and Preparation 260
Informed Consent 262
Image Guidance 262
Laboratory Evaluations 264
Antibiotics 264
Anesthesia 264
Needle Introduction and Placement 265
Venography 269
Cement Injection 269
Postoperative Care 271
Results 273
Complications 275
Pain relief after Vertebroplasty: Real or Sham 276
Conclusion 278
References 278
13 282
Implanted Drug Delivery Systems 282
Introduction 282
Personal Therapy Manager 285
Intraspinal Drug Delivery Clinic 285
Patient Selection 286
Patient Screening 288
Single Intrathecal Bolus Dosing 288
Continuous Epidural or Intrathecal Infusion Trials 288
System Implantation 289
Outcomes 292
Complications 292
Surgical Complications 292
Neurological Injury 292
Bleeding 293
Seroma Formation 293
Infection 294
Cerebrospinal Fluid Leak 295
Device-Related Complications 295
Allergic Reaction to the Pump and Catheter 297
Infusate-Related Complications 297
Conclusion 299
References 299
14 301
Endovascular Treatment of Vascular and Nonvascular Diseases of the Spine 301
Spinal Vascular Disease 301
Overview 301
Extradural AV Shunts 301
Epidural Arteriovenous Fistulas 303
Vertebral (Bony) and Epidural AV Shunts 303
Therapy 303
Extradural AVF 303
Extradural AVMs 303
Dural Arteriovenous Fistulas (Dorsal Intradural AVF or Type I) 303
Therapy 305
Intradural (Pial) Arteriovenous Fistula (Ventral Intradural AVF or Type IV) 305
Therapy 308
Extradural/Intradural AVM (Type III) 309
Therapy 309
Intramedullary AVM (Type II) 309
Therapy 310
Conus Medullaris AVM 311
Therapy 315
Isolated Spinal Aneurysms 315
Neoplastic Vascular Lesions of the Spinal Cord 315
Cavernous Malformations (Cavernous Angiomas) 315
Therapy 316
Hemangioblastomas 316
Therapy 316
Systemic Syndromes Associated with Spinal Vascular Disease 316
Osler–Weber–Rendu Syndrome (Hereditary Hemorrhagic Telangiectasia) 318
Cobb’s Syndrome 319
Klippel–Trenaunay and Parkes–Weber Syndrome 319
Therapy for Osler–Weber–Rendu Syndrome, Cobb’s Syndrome, KT Syndrome, and PW Syndrome 319
Neurofibromatosis Type-1 319
Therapy 320
Miscellaneous Vascular Lesions of the Vertebrae 320
Vertebral Hemangiomas 320
Type A: Lesions Causing Cord Compression 321
Therapy 321
Type B: Painful Lesions 323
Therapy 323
Type C: Asymptomatic Hemangiomas 324
Therapy 324
Aneurysmal Bone Cysts 324
Therapy 324
Neoplastic/Metastatic Lesions of the Spine 325
Recommended Technique for Spinal Angiography and Intervention 325
Neurophysiologic Monitoring During Embolization of Spinal Cord AV Shunts 333
Conclusion 334
References 334
15 339
Kyphoplasty: Balloon Assisted Vertebroplasty 339
Introduction 339
Patient Selection 341
Technique 342
Results 351
Biomechanical Investigations 353
Conclusion 354
References 354
16 356
Sacroplasty 356
Case Scenario 356
Typical Patient Presentation 356
Diagnosis 356
Conventional Treatment 356
Sacroplasty Option 358
Sacral Fractures and Sacroplasty 358
Incidence 358
Morbidity and Mortality 359
Diagnosis 359
Fracture Anatomy 362
Patient Selection 362
Technique 363
CT Guidance 363
Fluoroscopic Guidance 370
Outcomes 370
Complications 370
Complete Clinical Picture 370
Conclusion 372
References 372
17 375
Spinal Cord Stimulation: Uses and Applications 375
Introduction 375
The History of Neurostimulation 375
Gate Control Theory and Implantable Stimulators 376
Dorsal Roots 378
Chronic Back Pain 378
Failed Back Spinal Syndrome 378
Complex Regional Pain Syndrome 379
Postherpetic Neuralgia 381
Arachnoiditis 381
Phantom Limb Pain 382
Intercostal Neuralgia 382
Occipital Neuralgia (Peripheral Nerve Stimulator) 383
Angina Pectoris and Peripheral Vascular Disease 383
Interstitial Cystitis/Pelvic Pain 384
Technical Factors in Peripheral Stimulation 384
Technical Factors in Spinal Cord Stimulation 385
Complications 386
Techniques and Pearls of Implantation 387
CPT Coding Device 390
Device Manufacturers 391
Conclusion 394
References 395