Magnetic resonance (MR)-guided percutaneous pain therapy of degenerative spinal diseases

Computed Tomography (CT)-guided local injections offer a precise deposition of the medication within the region of the irritated sciatic nerve. To eli minate unnecessary radiation and to increase imaging capabilities, we have evaluated the feasibility of magnetic resonance (MR)-guided therapy of back pain and sciatica as well as MR-guided lumbar sympathectomy. The technique of MR-guided injection and MR-compatible cannulae have been developed and tested by using ex vivo specimens of the spine and an animal model. We trea ted 161 patients, ages 20 to 86 years (mean 51.5 years), 83 female and 78 m ale, with MR-guided periradicular injections up to five times (mean 2.3) ev ery 3 to 4 weeks at levels C5/6, C6/7, L3/4, L4/5, and L5/S1,facet joint ne urolysis at levels L4/5 and L5/S15, and infiltrations of the sacroiliac joi nts; 16 patients underwent chemical lumbar sympathectomy. All procedures we re performed successfully. Improvements of symptoms such as reduction of pa in of about 80% were noted in 70% of our patients; 16 (10%) patients requir ed other treatments. Despite moderate pain, no complications, such as bleed ing or infection, occurred. We demonstrated that MR-guided lumbar pain ther apy in a 0.2-tesla horizontal open magnet is feasible. The early clinical r esults are comparable to CT-guided pain therapy, but further technical impr ovements of the MR technology is required.