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Image-guided injections

Indications
• Osteoarthritis  of the vertebral joints or sacroiliac joint
• spinal deformity
• Facet syndrome (vertebral joint problems)
• pseudoradicular pain(local back pain, not radiating)
• blockage of the small vertebral joints

Principle
Under fluoroscopic (X-ray) control and possibly X-ray contrast agent injection special injection needle are directly placed within the affected joint. The accuracy can even be imprived by means of contrast agent. If the needle position is optimal, the injection of the drug takes place (mostly a mixture of cortisone and local anesthetic)

Importance
With image guided injection techniques targeted pain treatment is possible. An accurate diagnosis is essential. Complementary treatments such as physiotherapy is additionally required. The injections are often given three times at intervals of one to two weeks. The effect will be different. Usually in case of facet joint blockade after 3 injections the problem is resolved. When chronic facet syndrome (arthritis pain) is the problme, the effect may last for weeks to months. If positive, but not long-lasting effect, in a second Step one facet denervation, that is Obliteration of the pain-conducting nerves and thus interrupting the transmission to the brain, thereby preventing the perception of pain.

Advantages
Minimally invasive procedures can be performed in our outpatient practice. Complicated open surgery can be avoided and thus sometimes the oral medication consumption can be reduced.
Following this treatment a differentiated therapy should be initiated. Here, a specific spinal mucle training program should be completed with the deep muscles. The proprioceptive and functional training are very important tp get strong deep muscels.

Description of infiltration techniques as they are shown above

left
Infiltration into the so-called sacroiliac joint.
Above under image intensifier control, below under CT guidance.

center
Infiltration into the facet joint at the facet syndrome.
Above under image intensifier control, below under CT guidance.

right
Perineural infiltration in a patient with a herniated disc.
Above under image intensifier control, below under CT guidance.