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Keywords:
Interventional non-vascular, Management, Musculoskeletal spine, CT, Technical aspects
Authors:
S. A. Z. Khodair, E. Mashaly, H. Sameer; Qwuesna/EG
DOI:
10.1594/ecr2015/B-0345
Methods and materials
Research Ethics Committee approval and informed consent were obtained from all patients after explanation of the procedures,
their benefits and possible risks and how we overcome these risks..
Between January 2014 to January 2015 one hundred and twenty patients were included in this study,
( 74 male and 46 female ) aged between 21 – 69 years with a mean age of 41.6 years.
Their weight ranged from 65 to 100Kg with mean 77.45 Kg.
All patients had pain for a period ranged from 2 to 14 years and all used analgesics for at least 12 months.
50% of patients had radicular pain,
35% had low back pain while 15 % had referred pain.
The inclusion criteria were patients with chronic low back pain who had undergone adequate conservative treatment for this pain for at least 6 months without success.
The exclusion criteria were; presence of focal herniated intervertebral disc,
patient with motor deficit,
local or systemic infection and/or bleeding tendency.
Our study population was divided according to injection procedure into:
Group I: Patients underwent facet joint injection.
Group II: Patients underwent sacroiliac joint injection.
Group III: Patients underwent nerve root injection.
Group IV: Patients underwent more than one injection procedures.
All patients included in this study were subjected to; through history taken and pain scoring by Revised Oswestry disability index.
(This was done by a standard questionnaire before and after the injection by 1 month).
Neurological examination with special emphasis on spine examination.
Standard x-rays of the lumbar spine in 2 planes (antroposterior and lateral view) and MRI of the lumbar spine .
Technique of CT guided injection:
All spinal injections in our study were done under CT guidance ( TOSHIBA ,AQUILION 1,
multislice 320) with vital signs monitoring and complete aseptic precautions,
no sedation used. The patient was in a comfortable prone position,
a mark is situated upon the mid line overlying the region of interest,
CT scanning of the lumber vertebrae was taken.
The section of needle insertion was marked on the patient skin by the gaudiness of the machine laser light.
The angle of entrance,
distance from the midline and depth to the point where the needle tip was need to reach were measured to ensure an accurate placement of the needle.
After insertion of the 22 G spinal needle ,
2 ml of air was injected and re-scanning the site of the needle was done to evaluate its position and distribution of the air around the region of interest.
Once the position of the needle tip is confirmed,
a combination consisting of 2 ml of methyl prednisolone and1 ml mepivacaine 3%,
was injected.
Always aspirate before injection,
to exclude accidental intravascular location of needle.
The volume of the joint usually does not exceed 3 ml.