Learning objectives
To become familiar with the most common indications for minimally invasive imaging-guided techniques for MSK pain syndromes
To learn about technical considerations when performing minimally invasive imaging-guided techniques for MSK pain syndromes
To learn about evidenced based practice
Background
The therapeutic armamentarium of Interventional Radiology for painful MSK syndromes includes percutaneous infiltrations (usually a mixture of long acting corticosteroid and local anesthetic),
neurolysis (chemical by means of alcohol or phenol and thermal using radiofrequency or cryoablation),
neuromodulation (by means of pulsed radiofrequency),
intervertebral disc decompression and regeneration techniques,
vertebral and bone augmentation techniques.
In all the aforementioned techniques imaging guidance increases technical efficacy as well as safety rates whilst proper patient selection is a key factor.
Imaging findings OR Procedure Details
Interventional pain management may be employed for patients in whom the analgesic options on the WHO ladder and other adjuvant medications have proven ineffective.
Fig. 1
Fig.
1: WHO analgesic scale
References:2nd Department of Radiology,
University General Hospital
MSK pain syndromes in the spine include facet or sacroilliac joint syndromes,
Baastrup's disease,
coccygodynia,
intervertebral disc herniation and vertebral fractures.
Indications for Facet jointinfiltrations include pain of degenerative origin due to hypertrophic changes,
inflammation and synovial cysts.
Target point is the lower or upper joint part...
Conclusion
Interventional Radiology can offer minimally invasive,
imaging guided techniques for pain reduction and mobility improvement in painful MSK syndromes.
These techniques are safe,
efficacious and constitute attractive alternatives or first line therapies when compared to other conservative or surgical treatments.
Proper patient selection and imaging guidance are key factors.
References
FilippiadisD,
Charalampopoulos G,
Mazioti A,
Alexopoulou E,
Vrachliotis T,
Brountzos E,
Kelekis N,
Kelekis A.Interventional radiology techniques for pain reduction and mobility improvement in patients with knee osteoarthritis.Diagn Interv Imaging.
2019 Mar 29.
pii: S2211-5684(19)30069-5.
doi: 10.1016/j.diii.2019.02.011.
[Epub ahead of print]
Filler AG.
Diagnosis and treatment of pudendal nerve entrapmentsyndromesubtypes: imaging,
injections,
and minimal access surgery.Neurosurg Focus.
2009 Feb;26(2):E9.
FilippiadisDK,
Marcia S,
Ryan A,
Beall DP,
Masala S,
Deschamps F,
Kelekis A.New Implant-Based Technologies in the Spine.Cardiovasc Intervent Radiol.
2018 Oct;41(10):1463-1473.
Clementi D,
D'Ambrosi R,...
Personal Information
Dimitrios K Filippiadis MD,
PhD,
MSc,
EBIR
Assistant Professor of Diagnostic and Interventional Radiology
2nd Department of Radiology,
University General Hospital "ATTIKON"
Medical School,
National and Kapodistrian University of Athens
Addr.: 1 Rimini str,
12462 Haidari/Athens,
Greece
Tel.: +30 210 5831812
Fax: +30 2105326418
E mail:
[email protected],
[email protected]