Spinal CT–guided Interventional Procedures for Management of Chronic Back Pain
Section snippets
MATERIALS AND METHODS
After this prospective study was approved by the institutional review board, 111 consecutive patients referred from the back pain clinic to the radiology department for imageguided spinal infiltrations were treated during a 3-year interval from February 2000 to April 2003.
Technique
Patients were placed in prone position on the CT table with radiopaque markers on the skin at the affected level. Axial CT slices with use of lowdose protocols (110 kV, 120 mA) through the area of interest were obtained at 3-mm increments for precise selection of the needle pathway. The proper site of entry and angle of approach were then selected.
Sterile technique was followed and 3–5 mL of 1% lidocaine was used for cutaneous and local tract anesthesia. In all cases, a spinal 22-gauge Tuohy
RESULTS
Two hundred twenty-two blocks were performed in 111 patients (mean age, 61 years ± 14), 59% of whom (n = 66) were women and 41% of whom (n 45) were men. Women were older (mean age, 63 years ± 14) than men (mean age, 58 years ± 15; P = .25). The mean number of blocks per patient was 2 ± 1 (range, 1–10): 47 patients had one block, 45 had two, three had three, 13 had four, and three had five or more. The mean procedure duration was 15 minutes ± 2 per block (range, 11–20 min); mean observation time
DISCUSSION
The effect of chronic back pain in our society is enormous in terms of human suffering and cost (8). This problem affects a significant number of patients every year and is especially difficult to assess and evaluate as a result of the lack of correlation between clinical and imaging findings (1, 29). Recently, spinal infiltrations have become a useful tool for the diagnosis and management of chronic back pain, although their specific indications and technique are still controversial. CT offers
Acknowledgments
The authors thank Andres Rodriguez, MD, Jose Maria Rodriguez, MD, Enrique Jimenez, MD, and Fernando Hakim, MD, for their invaluable help with the clinical assessment of patients; and Sharon Kwan, MD, and Kristin Schueler, MD, for editing the manuscript.
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None of the authors have identified a conflict of interest.