Aims and objectives
FJ degeneration is responsible for up to 40% of Lower Back Pain (LBP).
FJ degeneration is easily detectable using Computed Tomography (CT) or Magnetic Resonance Imaging (MRI).
Although accurate CT/MRI guidance is definitely an expensive solution.
Ultrasound guidance itself may be attractive,
but it is too challenging because of a lack of detailed information in the vicinity of the bone.
Nowadays,
intra-articular injections and RFA are mainly performed using fluoroscopy or CT guidance.
If real-time ultrasound were able to avoid the problem of spatial resolution...
Methods and materials
An ultrasound scanner with Virtual Navigator (VN) was used (ESAOTE Italy).
Prone position lumbar spine 3D CT or MRI were obtained with a reference device fixed on the sacral region in 20 patients with FJ degenerative syndrome.
The active patient reference devices were placed on the patient’s body prior to CT (Fig 1) or MRI (Fig 2) series acquisition.
Within a period of 2 months,
patients were admitted for FJ injection (14) or RFA (6) and positioned in the prone position on the fluoroscopic table....
Results
The use of OmniTRAX allowed very fast co-registration (1 sec),
and the initial error never exceeded 8 mm.
Manual fine-tuning was mandatory in combination with one-point shift mode registration which reduced the final mismatch to 1-2 mm.
The total co-registration including manual fine tuning and one-point shift mode took about 3 minutes on average.
The use of the magnetic tracking system did not require any change to the standard technique.
Ultrasound-CT and ultrasound MRI fusion guidance was rapid (mean time 4 minutes) and accurate.
Before...
Conclusion
Our experience demonstrates that spine injections with ultrasound CT and ultrasound MRI fusion guidance is easy,
reliable,
and accurate,
despite the use of a multipurpose VN system available in a large number of radiological departments.
Reduction or absence of radiation,
such as in the case of Ultrasound-MRI fusion instead of solely CT/Fluoroscopy/Angiography,
without compromising precision or operator confidence,
was definitely a key issue.
References
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WCG Peh
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2011 Jan-Mar; 7(1): e4.
Published online 2011 Jan 1.
doi: 10.2349/biij.7.1.e4,
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3) Ultrasound-guided injections in the lumbar spine
Alexander Loizides,
Siegfried Peer,
Michaela Plaikner,
Verena Spiss,
Klaus Galiano,
Jochen Obernauer,
Hannes Gruber
Medical...