gms | German Medical Science

Objective: Periradicular infiltration therapy (PRT) is a standard diagnostic and therapeutic procedure which has been used in an outpatient setting over decades. With grown availability of low-dose computed tomography (CT) imaging, PRTs have been predominantely performed by radiologists. The study aims to analyse intervention time, radiation exposure and efficiacy of conventional PRT using fluoroscopy versus CT-guided injection.

Methods: Between July and November 2019, of 48 patients who underwent infiltration treatment, 15 patients (6 female, 9 male; age (median, 1 SD) 61.5±16.7 yrs) received CT-guided (Sensation 128, Siemens, Erlangen, Germany) as well as fluoroscopy-guided (Ziehm Vision RFD 3D, Ziehm Imaging, Nürnberg, Germany) PRT of lumbal and sacral nerve roots. Both interventions were performed using contrast agent (Solutrast) and local anesthetics. Pain reduction was recorded by changes in numerical rating scale (NRS). Duration of pain reduction, time of intervention, effective radiation dose and procedure-related complications were recorded.

Results: Preoperative diagnosis was radiculopathy due to neuroforaminal/recessal stenosis or disc herniation. Radicular numbness or paresthesia after injection of local anesthetic agent was seen in 12/15 patients in CT-PRT and 9/15 patients in fluoroscopy-guided PRT. Pain levels were reduced from NRS 8±1.6 to 4±2.7 lasting 18±22 days after CT-guided compared to 6.5±1.1 to 4.5±2.7 (p=0.031) lasting 26±20.9 days (n.s.) after fluoroscopy-guided treatment. Time of intervention was shorter using CT (5±2.3 min vs. 7±2.5 min, n.s.), however, fluoroscopy needed lower effective doses (2.82±0.55 mSv vs. 0.96±0.54 mSv, p<0.01). No complications occurred.

Conclusion: Even though treatment accuracy and pain reduction seems to be lower in fluoroscopy-guided PRT as compared to CT-guided injection, lower effective radiation dose as well as longer time span of pain relief and ubiquitous availability still justifies the use of this technique.