Learning objectives
The purpose of our educational exhibit is to:
1.
illustrate the normal anatomy and normal CT/MR-US fusion appearance of the lumbar spine with a special focus on facet joints,
nerve roots and sacroiliac joints.
2.
describe a systematic technique forfusion-guided interventional procedures around the spine
Background
Traditionally,
interventional procedures around the spine,
such as facet joint injections,
nerve root blocks and sacroiliac joint injections,
in a low back pain condition,
were performed under fluoroscopy or CT guidance (fig.
1),
that are considered the gold standard to achieve accurate guidance of the needle but expose the patient to a significant radiation dose,
even considering the possibility to repeat the therapeutic treatment over time.
Ultrasound suffers from poor visualization of the target due to itsdeep location,
frequent presence of bone spurs,
and greater...
Imaging findings OR Procedure Details
We present proceduresperformed with a newly developed echo-navigator (Masmec,
Italy) which enables probe-oriented or needle oriented procedures,
integrating the virtual tracking with fusion imaging (fig.4).
The patient is placed in a prone position on the bed,ready to perform the fusion imaging infiltration.
Step 1Ultrasound equipment and setting
We used a newly 'ECO-NAV’ fusion imaging system (MASMEC,
Italy),equipped with needle-tip sensors and 3-5 MHz convex probe withintegrated electromagnetic position sensors.
Theecho-navigatorintegrates the ultrasound machine with a low-intensity magnetic field generator docked by wire to the ultrasound...
Conclusion
Real-time fusion-guided needle insertion resulted a valuable procedure,
which allows for a quick,
safe and effective injection around lower spine.This procedure,using a single MRI data-set and avoiding radiation exposure,
itcan be of specific benefit in younger patients with chronic lower back pain,
in whom repeated injections are necessary over time .
References
Andersson GB (1998) Epidemiology of low back pain.
ActaOrthop Scand Suppl 281:28–3
Lynch MC,
Taylor JF (1986) Facet joint injection for low back pain.
A clinical study.
J Bone Joint Surg Br 68:138–141
Sartoris R,
Orlandi D,
Corazza A,
Sconfienza LM,
Arcidiacono A,
Bernardi SP,
Schiaffino S,
Turtulici G,
Caruso P,
Silvestri E (2017)In vivo feasibility of real-time MR-US fusion imaging lumbar facet joint injections.J Ultrasound 12;20(1):23-31
Boswell MV,
Colson JD,
Sehgal N,
Dunbar EE,
Epter R (2007) A systematic review of therapeutic facet joint...