Periradicular Infiltration Therapy

PRT, slipped disc, back pain, CT-guided infiltration

Definition

Periradicular therapy (PRT) is a pain therapy procedure for a herniated disc and other spinal diseases, in which a drug is injected near the exiting spinal nerves under computer tomographic imaging.

Introduction

In periradicular therapy (PRT), a mixture of drugs is injected in the area of a nerve root to relieve the pain associated with the nerve root. The drugs used are usually a mixture of local anesthetic and cortisone preparation. Periradicular therapy (around the nerve) Infiltration therapy (injection treatment) is a pain therapy procedure that is becoming increasingly important.

On behalf of mainly orthopaedic surgeons, the treatment is carried out by radiologists (X-ray doctors) in the outpatient area. In order to achieve the greatest possible effect, a series of 3-6 infiltrations is usually performed. The billing for this special form of treatment is paid by the health insurance company.

In the inpatient sector, periradicular therapy (PRT) is a component of the conservative orthopedic treatment options for back pain patients. In cases of unclear pain syndromes, the elimination of individual spinal nerves can help to prove the actual cause of the pain. Such information is also of great importance for a possible planned surgical procedure.

As in other areas, periradicular therapy in the cervical spine can be used to treat pain caused by a variety of factors. For example, compression of the exited nerves, nerve damage caused by herniated discs of the cervical spine or problems in connection with an accident, or scarring after a previous operation. The therapy can also be helpful for general problems caused by wear and tear.

When treating the cervical spine, the patient is in a lateral or prone position. The whole procedure is carried out under CT control, so that the attending physician can visually check during the whole procedure in which area the needle is located. In most cases, the exact dimensions of the affected area are determined beforehand using a CT image.

The injection of contrast medium allows for an exact control of the target area during the treatment. This is particularly important in the cervical spine area, since the nerves emerging here control many and sometimes vital body functions. If the physician has a high degree of certainty in the area of PRT, it is possible to dispense with the administration of contrast medium in order to increase the speed of the therapy and reduce the complication rate.

In addition to the actual periradicular therapy, in which the active substance is injected directly at the point of exit of the nerve root, there is also the possibility of performing the treatment in the area of the facet joints. These are the joints between the lateral parts of the cervical vertebrae. Particularly in the case of wear and tear, blockages or inflammation often occur in these.

Here, the injected cortisone/hyaluronic acid has an anti-inflammatory effect and prevents a further worsening of the symptoms and has an analgesic effect. The improvement of the symptoms generally occurs immediately or after 1-3 days. This treatment is usually repeated at intervals of 1-3 weeks, a total of 3 times, in order to achieve a permanent subsiding of the inflammation and a long-term inhibition of the pain-processing nerve fibers.

This is the only way to prevent the development of a so-called pain memory and thus prevent or break through chronic pain. Periradicular therapy is also frequently used in the lumbar spine area. The spectrum of application here also lies mainly in the area of herniated discs, incarcerations (see: sciatic nerve incarcerated) and other chronic degenerative changes.

These occur in a particularly large number of people in the area of the lumbar spine. In old age, this carries up to 70% of the body weight due to the increasing loss of normal intervertebral discs. In contrast to PRT in the cervical spine, treatment here is always performed in the prone position.

Especially in the lumbar spine area, periradicular therapy under MRI control is an interesting alternative to the usual CT-supported injection.Since the very radiation-sensitive genitals are located near the lumbar spine in the pelvic region, younger patients in particular should be treated with special radiation-saving measures. Treatment of the facet joints and so-called epidural therapy are also possible in the lumbar spine area. In epidural therapy, not only a single nerve root is treated.

Instead, the active ingredient is introduced above the dura mater (hard meninges) into the area between the spinal cord and the bone. This is particularly advantageous when several nerve roots are affected. As in the other areas of the spine, periradicular therapy can only relieve symptoms in the lumbar region.

The actual cause is not combated. However, the anti-inflammatory effect slows down further deterioration and allows the body to heal part of the defect. Due to the radiation exposure described above, when using CT or X-ray assisted procedures, it should always be considered, especially in the lumbar region, whether other methods of pain relief are also possible.