The course of radicular pain is manifold, and when it is produced by disc herniation it is amenable to minimally invasive treatment, either by chemonucleolysis or arthroscopic microdiscectomy. Chemonucleolysis has been established in over 25 years of clinical use as a safe and effective procedure with over all safety rates equal to, if not better than, that of open discectomy. Failure has been attributed to inability of the enzymes to digest the collagenized nucleus tissue commonly present in subligamentous and extraligamentous sequestered herniations in the older-aged population. Technically, percutaneous arthroscopic microdiscectomy is a more demanding procedure, but it is also reasonably safe, with a wider range of indications and better success rates. This report describes our knowledge of surgical techniques, pitfalls, indications and contraindications gained through years of experience with these two imaging guided techniques. Low back pain may originate from multiple spinal structures, with some structures contributing more than others to the clinical manifestation of pain at a given point. The facet joints are theorized to be one source of low back pain. Facet joint infiltration should be considered as a confirmatory test for diagnosing clinically suspected facet syndrome. Facet rhizolysis, which is reputed to be the definitive form of treatment for facetogenic pain, is a minimally invasive therapeutic modality with an average success rate of about 50%, according to our research and that of others. We detail the pitfalls of this technique and its applications for the treatment of osteoid osteoma of the spine. Spondylodiscitis normally heals itself but it can cause bone destruction leading to deformity and often pain. Debridement of these infections can accelerate natural healing and prevent progression and bone destruction. We describe our experience with percutaneous transpedicular discectomy and its effectiveness, indications and contraindications, including recommendations on the choice of general versus local anesthesia, access to the intended discectomy level, and the use of fluoroscopic guidance.
|Original language||English (US)|
|Number of pages||22|
|Journal||Journal of Interventional Radiology|
|State||Published - 1999|
ASJC Scopus subject areas
- Radiology Nuclear Medicine and imaging