Pub Date : 2024-12-01DOI: 10.1016/j.tvir.2024.101011
Merve Ozen MD , Nicholas Meredith
The field of interventional radiology is facing a growing demand for percutaneous procedures targeting smaller and more complex lesions. Percutaneous medical robots have proven to increase efficiency and accuracy and can address these issues. This review is intended to provide an overview of the functionality and components of these robotic systems for operators learning to use them. We begin by discussing the functions of robots in percutaneous interventions and how they operate. After this discussion, greater focus is then placed on the technical components of robots which help achieve these functions.
{"title":"Components of Robotic Systems in Image-Guided Percutaneous Interventions","authors":"Merve Ozen MD , Nicholas Meredith","doi":"10.1016/j.tvir.2024.101011","DOIUrl":"10.1016/j.tvir.2024.101011","url":null,"abstract":"<div><div>The field of interventional radiology is facing a growing demand for percutaneous procedures targeting smaller and more complex lesions. Percutaneous medical robots have proven to increase efficiency and accuracy and can address these issues. This review is intended to provide an overview of the functionality and components of these robotic systems for operators learning to use them. We begin by discussing the functions of robots in percutaneous interventions and how they operate. After this discussion, greater focus is then placed on the technical components of robots which help achieve these functions.</div></div>","PeriodicalId":51613,"journal":{"name":"Techniques in Vascular and Interventional Radiology","volume":"27 4","pages":"Article 101011"},"PeriodicalIF":1.4,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143016102","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-12-01DOI: 10.1016/j.tvir.2024.101006
Govindarajan Narayanan MD , Ripal T. Gandhi MD , Bente A.T. van den Bemd MD
Robotic systems for minimally invasive procedures, particularly in interventional oncology, have advanced significantly, especially for percutaneous interventions guided by CT, Cone-beam CT, and MRI. These systems, which include needle-guiding and needle-driving robots, enhance the precision of procedures like biopsy and tumor ablation. Needle-guiding robots plan and align the needle, while needle-driving robots autonomously advance it, improving needle placement accuracy, enabling out-of-plane insertion, and reducing radiation exposure. These robotic systems offer key clinical benefits, such as stable needle guidance for challenging angulated approaches and better access to lesions in confined spaces, like CT or MRI gantries. They can guide the needle to the optimal region of a lesion without the need for a second contrast injection, improving both diagnosis and treatment. While many robotic systems have been developed, only a few have reached clinical use. Early studies show promising results, but concerns about increased complexity and cost remain. Further research and clinical trials are needed to fully evaluate their value, though we believe that robotic systems will play an increasingly important role in the future of image-guided interventions, particularly for challenging tumors.
{"title":"Image Guided Percutaneous Robotic Interventions for Solid Organs","authors":"Govindarajan Narayanan MD , Ripal T. Gandhi MD , Bente A.T. van den Bemd MD","doi":"10.1016/j.tvir.2024.101006","DOIUrl":"10.1016/j.tvir.2024.101006","url":null,"abstract":"<div><div>Robotic systems for minimally invasive procedures, particularly in interventional oncology, have advanced significantly, especially for percutaneous interventions guided by CT, Cone-beam CT, and MRI. These systems, which include needle-guiding and needle-driving robots, enhance the precision of procedures like biopsy and tumor ablation. Needle-guiding robots plan and align the needle, while needle-driving robots autonomously advance it, improving needle placement accuracy, enabling out-of-plane insertion, and reducing radiation exposure. These robotic systems offer key clinical benefits, such as stable needle guidance for challenging angulated approaches and better access to lesions in confined spaces, like CT or MRI gantries. They can guide the needle to the optimal region of a lesion without the need for a second contrast injection, improving both diagnosis and treatment. While many robotic systems have been developed, only a few have reached clinical use. Early studies show promising results, but concerns about increased complexity and cost remain. Further research and clinical trials are needed to fully evaluate their value, though we believe that robotic systems will play an increasingly important role in the future of image-guided interventions, particularly for challenging tumors.</div></div>","PeriodicalId":51613,"journal":{"name":"Techniques in Vascular and Interventional Radiology","volume":"27 4","pages":"Article 101006"},"PeriodicalIF":1.4,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143016108","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-09-01DOI: 10.1016/j.tvir.2024.100990
Hanzhou Li , John T. Moon , Vishal Shankar , Janice Newsome , Judy Gichoya , Zachary Bercu
Musculoskeletal (MSK) pain leads to significant healthcare utilization, decreased productivity, and disability globally. Due to its complex etiology, MSK pain is often chronic and challenging to manage effectively. Disparities in pain management—influenced by provider implicit biases and patient race, gender, age, and socioeconomic status—contribute to inconsistent outcomes. Interventional radiology (IR) provides innovative solutions for MSK pain through minimally invasive procedures, which can alleviate symptoms and reduce reliance on opioids. However, IR services may be underutilized, especially due to current treatment paradigms, referral patterns, and in areas with limited access to care. Artificial intelligence (AI) presents a promising avenue to address these inequities by analyzing large datasets to identify disparities in pain management, recognizing implicit biases, improving cultural competence, and enhancing pain assessment through multimodal data analysis. Additionally, patients who may benefit from an IR pain procedure for their MSK pain may then receive more information through their providers after being identified as a candidate by AI sifting through the electronic medical record. By leveraging AI, healthcare providers can potentially mitigate their biases while ensuring more equitable pain management and better overall outcomes for patients.
在全球范围内，肌肉骨骼（MSK）疼痛导致大量医疗保健使用、生产力下降和残疾。由于病因复杂，MSK 疼痛通常是慢性的，难以有效控制。受医疗服务提供者的隐性偏见以及患者的种族、性别、年龄和社会经济地位的影响，疼痛治疗中存在的差异导致了治疗结果的不一致。介入放射学（IR）通过微创手术为 MSK 疼痛提供了创新的解决方案，可减轻症状并减少对阿片类药物的依赖。然而，介入放射学服务可能未得到充分利用，特别是由于目前的治疗模式、转诊模式以及在医疗服务有限的地区。人工智能（AI）通过分析大型数据集来识别疼痛管理中的差异、识别隐性偏见、提高文化能力，并通过多模态数据分析来加强疼痛评估，为解决这些不公平现象提供了一条前景广阔的途径。此外，在人工智能通过电子病历筛选出候选者后，可能从 IR 疼痛程序中获益的 MSK 疼痛患者可以通过医疗服务提供者获得更多信息。通过利用人工智能，医疗服务提供者有可能减少他们的偏见，同时确保为患者提供更公平的疼痛管理和更好的整体治疗效果。
{"title":"Health inequities, bias, and artificial intelligence","authors":"Hanzhou Li , John T. Moon , Vishal Shankar , Janice Newsome , Judy Gichoya , Zachary Bercu","doi":"10.1016/j.tvir.2024.100990","DOIUrl":"10.1016/j.tvir.2024.100990","url":null,"abstract":"<div><div>Musculoskeletal (MSK) pain leads to significant healthcare utilization, decreased productivity, and disability globally. Due to its complex etiology, MSK pain is often chronic and challenging to manage effectively. Disparities in pain management—influenced by provider implicit biases and patient race, gender, age, and socioeconomic status—contribute to inconsistent outcomes. Interventional radiology (IR) provides innovative solutions for MSK pain through minimally invasive procedures, which can alleviate symptoms and reduce reliance on opioids. However, IR services may be underutilized, especially due to current treatment paradigms, referral patterns, and in areas with limited access to care. Artificial intelligence (AI) presents a promising avenue to address these inequities by analyzing large datasets to identify disparities in pain management, recognizing implicit biases, improving cultural competence, and enhancing pain assessment through multimodal data analysis. Additionally, patients who may benefit from an IR pain procedure for their MSK pain may then receive more information through their providers after being identified as a candidate by AI sifting through the electronic medical record. By leveraging AI, healthcare providers can potentially mitigate their biases while ensuring more equitable pain management and better overall outcomes for patients.</div></div>","PeriodicalId":51613,"journal":{"name":"Techniques in Vascular and Interventional Radiology","volume":"27 3","pages":"Article 100990"},"PeriodicalIF":1.4,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142535414","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Chronic abdominal visceral pain management often requires multidisciplinary collaboration. Image-guided visceral nerve interventions may be critical in the management of visceral pain refractory to medical treatments. Abdominal and pelvic pain is mediated by specific nerves involving specific ganglia. The well-defined location of these ganglia provides important targets for percutaneous image-guided interventions to alleviate chronic abdominal or pelvic pain. In this review, we provide an in-depth discussion of the anatomy, indications, evidence, and technical and clinical considerations and complications for celiac plexus, superior hypogastric, inferior hypogastric, and ganglion impar block and neurolysis.
{"title":"Visceral nerve interventions in interventional radiology","authors":"Shen Ning, Samir Ghandour, Ashraf Thabet, Shams Iqbal","doi":"10.1016/j.tvir.2024.100983","DOIUrl":"10.1016/j.tvir.2024.100983","url":null,"abstract":"<div><div>Chronic abdominal visceral pain management often requires multidisciplinary collaboration. Image-guided visceral nerve interventions may be critical in the management of visceral pain refractory to medical treatments. Abdominal and pelvic pain is mediated by specific nerves involving specific ganglia. The well-defined location of these ganglia provides important targets for percutaneous image-guided interventions to alleviate chronic abdominal or pelvic pain. In this review, we provide an in-depth discussion of the anatomy, indications, evidence, and technical and clinical considerations and complications for celiac plexus, superior hypogastric, inferior hypogastric, and ganglion impar block and neurolysis.</div></div>","PeriodicalId":51613,"journal":{"name":"Techniques in Vascular and Interventional Radiology","volume":"27 3","pages":"Article 100983"},"PeriodicalIF":1.4,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142535407","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-09-01DOI: 10.1016/j.tvir.2024.100988
Koustav Pal MBBS, Rahul A. Sheth MD FSIR, Milan N. Patel MD
This technical review provides a comprehensive overview of spinal tumor ablation and vertebral augmentation. These percutaneous minimally invasive procedures offer significant survival and palliative pain relief benefits for patients with pathological vertebral fractures. Vertebral augmentation, which includes vertebroplasty and kyphoplasty, involves injecting cement into fractured vertebral bodies to restore height. While vertebroplasty involves the direct injection of cement into a fractured vertebral body, kyphoplasty involves using a balloon to create a low-pressure cavity to allow for cement injection to restore the vertebral body height. Over the years, this technique has evolved into a straightforward process, though it presents certain technical challenges discussed in this article.
{"title":"Keeping it \"straight\": how to do spinal tumor ablation with vertebral augmentation","authors":"Koustav Pal MBBS, Rahul A. Sheth MD FSIR, Milan N. Patel MD","doi":"10.1016/j.tvir.2024.100988","DOIUrl":"10.1016/j.tvir.2024.100988","url":null,"abstract":"<div><div>This technical review provides a comprehensive overview of spinal tumor ablation and vertebral augmentation. These percutaneous minimally invasive procedures offer significant survival and palliative pain relief benefits for patients with pathological vertebral fractures. Vertebral augmentation, which includes vertebroplasty and kyphoplasty, involves injecting cement into fractured vertebral bodies to restore height. While vertebroplasty involves the direct injection of cement into a fractured vertebral body, kyphoplasty involves using a balloon to create a low-pressure cavity to allow for cement injection to restore the vertebral body height. Over the years, this technique has evolved into a straightforward process, though it presents certain technical challenges discussed in this article.</div></div>","PeriodicalId":51613,"journal":{"name":"Techniques in Vascular and Interventional Radiology","volume":"27 3","pages":"Article 100988"},"PeriodicalIF":1.4,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142535412","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-09-01DOI: 10.1016/j.tvir.2024.100981
Ben McCafferty MD , Roger Williams DO
An epidural steroid injection (ESI) is a minimally invasive, image guided procedure for the treatment of back pain. Pain originating in the lumbar spine is the most common referral for ESI but the entire spine may be targeted. ESI can provide temporary but meaningful relief for patients who may have failed conservative management with oral analgesics and physical therapy. ESI may provide analgesia and anti-inflammatory effects that allow more conservative measures like physical therapy to become more effective. ESI also serves as a bridge between conservative and surgical management, intervention for postsurgical pain, or an alternative for nonsurgical candidates. This article reviews the technique for performing ESI in the cervical, thoracic, and lumbosacral spine.
硬膜外类固醇注射（ESI）是一种微创、图像引导的治疗背部疼痛的方法。腰椎疼痛是 ESI 最常见的转诊病因，但也可针对整个脊柱进行治疗。对于口服止痛药和物理疗法等保守疗法无效的患者，ESI 可以提供暂时但有意义的缓解。ESI 可提供镇痛和消炎效果，使物理治疗等保守治疗变得更加有效。ESI 还可作为保守治疗和手术治疗之间的桥梁，对手术后疼痛进行干预，或作为非手术候选者的替代治疗方法。本文回顾了在颈椎、胸椎和腰骶部实施 ESI 的技术。
{"title":"Epidural steroid injection technique","authors":"Ben McCafferty MD , Roger Williams DO","doi":"10.1016/j.tvir.2024.100981","DOIUrl":"10.1016/j.tvir.2024.100981","url":null,"abstract":"<div><div>An epidural steroid injection (ESI) is a minimally invasive, image guided procedure for the treatment of back pain. Pain originating in the lumbar spine is the most common referral for ESI but the entire spine may be targeted. ESI can provide temporary but meaningful relief for patients who may have failed conservative management with oral analgesics and physical therapy. ESI may provide analgesia and anti-inflammatory effects that allow more conservative measures like physical therapy to become more effective. ESI also serves as a bridge between conservative and surgical management, intervention for postsurgical pain, or an alternative for nonsurgical candidates. This article reviews the technique for performing ESI in the cervical, thoracic, and lumbosacral spine.</div></div>","PeriodicalId":51613,"journal":{"name":"Techniques in Vascular and Interventional Radiology","volume":"27 3","pages":"Article 100981"},"PeriodicalIF":1.4,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142534977","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-09-01DOI: 10.1016/j.tvir.2024.100979
Junaid Raja MD MSPH , Jake DiFatta BS , Junjian Huang MD , Dana Dunleavy MD
Vertebral augmentation consists of minimally invasive techniques indicated in the treatment of vertebral compression fractures (VCFs). These compression fractures cause vertebral body height loss and consequent significant pain and are most frequently the result of osteoporosis, cancer metastasis, or trauma. The deleterious effects of VCFs often compound, as greater load-bearing stress is transferred to the remaining healthy vertebrae. Kyphoplasty, vertebroplasty, and intravertebral implants are closely related vertebral augmentation techniques that serve to relieve pain and to counter pathophysiological stress and structural degradation of the vertebral column alignment. All 3 approaches are performed percutaneously and are therefore attractive options for patients deemed to be poor candidates for open surgery.
Each technique involves transpedicular needle access to the vertebral body matrix, followed by introduction of a cement-like polymer through a catheter to fill the space and provide structural fortification. Vertebroplasty involves injection of the cement material into the matrix space without any adjunctive measures. In kyphoplasty, a balloon is first introduced to expand the collapsed, fractured area with the goal of approximating the prefracture anatomy of the vertebral body and thereby spinal curvature, promptly followed by cement introduction. In intravertebral implantation procedures, a permanent jack is inserted into the vertebral body matrix and expanded craniocaudally, with the same purpose of restoring normal structure, before the matrix space is filled with cement polymer. This article provides an overview of these vertebral augmentation techniques, including pre and postprocedural considerations, with an emphasis on the technical aspects of the interventions.
{"title":"Vertebral augmentation: How we do it","authors":"Junaid Raja MD MSPH , Jake DiFatta BS , Junjian Huang MD , Dana Dunleavy MD","doi":"10.1016/j.tvir.2024.100979","DOIUrl":"10.1016/j.tvir.2024.100979","url":null,"abstract":"<div><div>Vertebral augmentation consists of minimally invasive techniques indicated in the treatment of vertebral compression fractures (VCFs). These compression fractures cause vertebral body height loss and consequent significant pain and are most frequently the result of osteoporosis, cancer metastasis, or trauma. The deleterious effects of VCFs often compound, as greater load-bearing stress is transferred to the remaining healthy vertebrae. Kyphoplasty, vertebroplasty, and intravertebral implants are closely related vertebral augmentation techniques that serve to relieve pain and to counter pathophysiological stress and structural degradation of the vertebral column alignment. All 3 approaches are performed percutaneously and are therefore attractive options for patients deemed to be poor candidates for open surgery.</div><div>Each technique involves transpedicular needle access to the vertebral body matrix, followed by introduction of a cement-like polymer through a catheter to fill the space and provide structural fortification. Vertebroplasty involves injection of the cement material into the matrix space without any adjunctive measures. In kyphoplasty, a balloon is first introduced to expand the collapsed, fractured area with the goal of approximating the prefracture anatomy of the vertebral body and thereby spinal curvature, promptly followed by cement introduction. In intravertebral implantation procedures, a permanent jack is inserted into the vertebral body matrix and expanded craniocaudally, with the same purpose of restoring normal structure, before the matrix space is filled with cement polymer. This article provides an overview of these vertebral augmentation techniques, including pre and postprocedural considerations, with an emphasis on the technical aspects of the interventions.</div></div>","PeriodicalId":51613,"journal":{"name":"Techniques in Vascular and Interventional Radiology","volume":"27 3","pages":"Article 100979"},"PeriodicalIF":1.4,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142535405","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-09-01DOI: 10.1016/j.tvir.2024.100985
Dr. George Zlotchenko MD , Dr. Thor Johnson MD, PhD , Katherine Kelson BA
Cancer patients experience pain at significant rates but are often undertreated—it is estimated that less than 1% of eligible cancer pain patients receive appropriate targeted drug delivery to address their pain. Cancer pain is often managed with systemic opioid treatment; however, this approach is limited in treating pain adequately and carries significant side effect risk profiles. Successful treatment of pain is closely tied to better oncologic outcomes as well as better measures on assessments of quality of life for cancer patients. Placement of intrathecal pain pumps represent a safe and effective way to manage pain in cancer patients. We describe the process of placing intrathecal pain pumps in an interventional radiology suite. This method of pump placement represents a minimally invasive approach to long term and continuous pain relief. Intrathecal pain pumps help maximize pain control for patients experiencing refractory pain due to disease process or treatments associated with malignancy.
{"title":"Targeted drug delivery via intrathecal pain pump for the treatment of malignant pain","authors":"Dr. George Zlotchenko MD , Dr. Thor Johnson MD, PhD , Katherine Kelson BA","doi":"10.1016/j.tvir.2024.100985","DOIUrl":"10.1016/j.tvir.2024.100985","url":null,"abstract":"<div><div>Cancer patients experience pain at significant rates but are often undertreated—it is estimated that less than 1% of eligible cancer pain patients receive appropriate targeted drug delivery to address their pain. Cancer pain is often managed with systemic opioid treatment; however, this approach is limited in treating pain adequately and carries significant side effect risk profiles. Successful treatment of pain is closely tied to better oncologic outcomes as well as better measures on assessments of quality of life for cancer patients. Placement of intrathecal pain pumps represent a safe and effective way to manage pain in cancer patients. We describe the process of placing intrathecal pain pumps in an interventional radiology suite. This method of pump placement represents a minimally invasive approach to long term and continuous pain relief. Intrathecal pain pumps help maximize pain control for patients experiencing refractory pain due to disease process or treatments associated with malignancy.</div></div>","PeriodicalId":51613,"journal":{"name":"Techniques in Vascular and Interventional Radiology","volume":"27 3","pages":"Article 100985"},"PeriodicalIF":1.4,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142535409","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-09-01DOI: 10.1016/j.tvir.2024.100986
Christopher Paul MD, Rene Powell DO, Prentiss Lawson MD
Since the introduction of spinal cord stimulation in 1967, the therapy has become a cornerstone in the treatment of several chronic pain syndromes, including but not limited to: postlaminectomy syndrome, lumbar radiculopathy, complex regional pain syndrome and diabetic peripheral neuropathy. This article aims to examine the methodology and practical considerations involved in thoracolumbar spinal cord stimulation implementation, emphasizing procedural techniques and critical criteria for selecting patients to achieve optimal outcomes and minimization of complications.
{"title":"Thoracolumbar spinal cord stimulation: technique and overview","authors":"Christopher Paul MD, Rene Powell DO, Prentiss Lawson MD","doi":"10.1016/j.tvir.2024.100986","DOIUrl":"10.1016/j.tvir.2024.100986","url":null,"abstract":"<div><div>Since the introduction of spinal cord stimulation in 1967, the therapy has become a cornerstone in the treatment of several chronic pain syndromes, including but not limited to: postlaminectomy syndrome, lumbar radiculopathy, complex regional pain syndrome and diabetic peripheral neuropathy. This article aims to examine the methodology and practical considerations involved in thoracolumbar spinal cord stimulation implementation, emphasizing procedural techniques and critical criteria for selecting patients to achieve optimal outcomes and minimization of complications.</div></div>","PeriodicalId":51613,"journal":{"name":"Techniques in Vascular and Interventional Radiology","volume":"27 3","pages":"Article 100986"},"PeriodicalIF":1.4,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142535410","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-09-01DOI: 10.1016/j.tvir.2024.100987
John B. Smirniotopoulos MS, MD , Uchenna Osuala MS , Clark R. Restrepo MD , Junjian Huang MD
Chronic low back pain represents a leading cause of global disability, but can often be complex in etiology, with multiple pain generators contributing to patient discomfort. Anterior column low back pain involves the vertebral bodies and discs, with the vertebral body endplates now known to be a significant pain generator. Vertebrogenic low back pain secondary to irritation of the basivertebral nerve presents as axial discomfort, worse with forward flexion, and with concomitant Type I or II Modic changes on MRI. Minimally invasive basivertebral nerve radiofrequency ablation has emerged as an effective intervention for managing anterior column back pain. In this article, the authors present a comprehensive approach to identifying and treating vertebrogenic low back pain through image guided basivertebral nerve ablation. We outline the patient presentation and diagnostic workup, followed by a detailed procedural guide including equipment requirements, technique execution, and potential technical challenges and complications.
慢性腰背痛是导致全球残疾的一个主要原因，但其病因往往很复杂，有多种致痛因素导致患者不适。前柱性腰痛涉及椎体和椎间盘，目前已知椎体终板是重要的疼痛源。继发于椎基底神经刺激的椎源性腰痛表现为轴向不适，前屈时加重，核磁共振成像上伴有 I 型或 II 型 Modic 改变。微创椎基底神经射频消融术已成为治疗前柱腰痛的有效干预方法。在本文中，作者介绍了一种通过图像引导椎基底神经消融术识别和治疗椎源性腰痛的综合方法。我们概述了患者的表现和诊断工作，随后提供了详细的程序指南，包括设备要求、技术执行以及潜在的技术挑战和并发症。
{"title":"Basivertebral nerve ablation technique","authors":"John B. Smirniotopoulos MS, MD , Uchenna Osuala MS , Clark R. Restrepo MD , Junjian Huang MD","doi":"10.1016/j.tvir.2024.100987","DOIUrl":"10.1016/j.tvir.2024.100987","url":null,"abstract":"<div><div>Chronic low back pain represents a leading cause of global disability, but can often be complex in etiology, with multiple pain generators contributing to patient discomfort. Anterior column low back pain involves the vertebral bodies and discs, with the vertebral body endplates now known to be a significant pain generator. Vertebrogenic low back pain secondary to irritation of the basivertebral nerve presents as axial discomfort, worse with forward flexion, and with concomitant Type I or II Modic changes on MRI. Minimally invasive basivertebral nerve radiofrequency ablation has emerged as an effective intervention for managing anterior column back pain. In this article, the authors present a comprehensive approach to identifying and treating vertebrogenic low back pain through image guided basivertebral nerve ablation. We outline the patient presentation and diagnostic workup, followed by a detailed procedural guide including equipment requirements, technique execution, and potential technical challenges and complications.</div></div>","PeriodicalId":51613,"journal":{"name":"Techniques in Vascular and Interventional Radiology","volume":"27 3","pages":"Article 100987"},"PeriodicalIF":1.4,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142535411","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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