Periradicular therapy (PRT) is an injection used to treat pain around the nerve roots of the spine. Back pain is common and often chronic. Here, PRT promises a pain-relieving or pain-relieving option, depending on the cause of the back pain.
What is periradicular therapy?
Periradicular therapy involves using an imaging procedure – usually CT – to pinpoint the exact point of pain, where various medications are injected to eliminate or at least relieve pain conditions. In the case of periradicular therapy, the exact point of the pain-producing area is determined in an imaging procedure – usually under CT – and the elimination or at least alleviation of the pain conditions is achieved there with millimeter precision through the injection of various medications. The injection of a local anesthetic and/or an anti-inflammatory drug is always planned. The choice depends on the underlying disease of the spine. The procedure can be performed at one point of the spine or simultaneously at several points. Most often, the treatment area is in the lumbar spine region, between the third and fifth lumbar vertebrae.
Function, effect and goals
During the treatment, the patient lies on a special table in the prone position and the first step is to take stock of the situation in order to determine the location of the vertebrae, intervertebral discs and joints and to determine the exact point for the injection. This localization is done with absolute precision. Before the puncture or hollow needle is inserted, the site is marked. If the hollow needle is then used to puncture the corresponding location, a CT scan is then taken again (this is an X-ray tube or ring, because it is open to the front again. A measuring system moves around the body in the ring. Cross-sectional images are then created by computer from the results. Radiation exposure from CT is low, but higher than from ordinary X-ray exams). The needle may need to be repositioned and the procedure repeated. Only when the puncture needle is in exactly the right place can the appropriate drugs be injected there. Sometimes there is so little space there that a contrast medium is injected through the hollow needle to make soft tissues, blood vessels and nerves visible. A single treatment is not sufficient in this procedure. It also does not help all people in the long term, but it does help a large proportion whose back pain can be relieved or taken away, thus restoring a certain quality of life. Many people feel a success already after the first treatment. In about seventy percent of patients, lasting pain relief – or even freedom from pain – can be achieved. At some point, however, pain conditions may reappear and treatment may be repeated accordingly.
Risks, side effects and dangers
Anesthetics – or anti-inflammatory agents, as well as the contrast medium used, if any, can cause side effects. These are mainly allergic reactions such as itching, nausea, headache or vomiting. Before treatment, however, patients are asked about known hypersensitivity reactions or other previous illnesses. Rarely, circulatory reactions may also occur, but these are usually immediate and can still be treated during the subsequent observation phase. There is also the possibility of severe intolerance reactions which can even be life-threatening, e.g. due to organ damage. However, this happens extremely rarely. If the local anesthetic gets directly into a blood vessel, it can spread throughout the body and, in the worst case, lead to impaired consciousness or cardiovascular reactions. In rare cases, the anesthetic may also enter the spinal canal, causing sensory disturbances or temporary paralysis. Permanent or long-term paralysis as a result of bruising or infection in the area of the spinal canal or due to nerve injury is extremely rare. The cortisone preparation is only used in small quantities, so that longer-lasting side effects are generally not to be expected. However, blood glucose levels may rise temporarily and women may experience short-term menstrual irregularities.Since any contrast medium injected contains iodine, the thyroid gland may react. These can be treated and are not permanent. Patients with thyroid disease, such as Hashimoto’s disease, should have TSH levels and free thyroid hormones checked and, if necessary, have the dose of the drug levothyroxine adjusted.
