Percutaneous nucleotomy with CT and fluoroscopic guidance

Combined Angio-CT Systems: A Roadmap Tool for Precision Therapy in Interventional Oncology

Combined angiography-CT (angio-CT) systems, which combine traditional angiographic imaging with cross-sectional imaging, are a valuable tool for interventional radiology. Although cone-beam CT (CBCT) technology from flat-panel angiography systems has been established as an adjunct cross-sectional imaging tool during interventional procedures, the intrinsic advantages of angio-CT systems concerning superior soft-tissue imaging and contrast resolution, along with operational ease, have sparked renewed interest in their use in interventional oncology procedures. Owing to increases in affordability and usability due to an improved workflow, angio-CT systems have become a viable alternative to stand-alone flat-panel angiographic systems equipped with CBCT. This review aims to provide a comprehensive technical and clinical guide for the use of angio-CT systems in interventional oncology. The basic concepts related to the use of angio-CT systems, including concepts related to workflow setup, imaging characteristics, and acquisition parameters, will be discussed. Additionally, an overview on the clinical applications and the benefits of angio-CT systems in routine therapeutic and palliative interventional oncology procedures will be reviewed. Keywords: Ablation Techniques, CT-Angiography, Interventional-Body, Interventional-MSK, Chemoembolization, Embolization, Radiation Therapy/Oncology, Abdomen/GI, Skeletal-Axial Supplemental material is available for this article. © RSNA, 2021.

Trattamento della lombosciatalgia acuta e cronica con infiltrazione perigangliare di steroide

Scopo del nostro lavoro è stato quello di valutare l'efficacia di un'infiltrazione perigangliare di steroide in pazienti affetti da lombosciatalgia acuta o cronica.

56 pazienti affetti da lombosciatalgia dipendente da patologia degenerativa discale o vertebrale, con pregressa valutazione TC e/o RM del rachide lombare, sono stati sottoposti ad una infiltrazione TC guidata perigangliare, con 2 cc (80 mgr) di Depomedrol® usando un ago di Chiba spinale centimetrato da 22 g, senza effettuazione di alcuna preparazione, anestesia o somministrazione di mezzo di contrasto. La lombosciatalgia, e la sua evoluzione a 1 e 12 mesi dal trattamento, è stata valutata mediante scala “Owestry low back pain disability scale”.

Il 71% dei pazienti dimostrava un significativo miglioramento della sintomatologia, con scomparsa o riduzione della sintomatologia. In conclusione, il trattamento periradicolare TC guidato con iniezione di steroide sembra costituire una valida alternativa minimamente invasiva per il trattamento della patologia radicolare lombare.

Percutaneous Laser Disc Decompression for the Treatment of Lumbar Disc Herniation: A Review

BACKGROUND

Discontinuation of the marketing of chymodactin has reawakened interest in other percutaneous techniques for treating lumbar disc herniation. Developed in the 1980s, the concept of laser disc decompression is based on the percutaneous introduction of an optical fiber into the intervertebral disc and administering laser energy. The procedure allows for the vaporization of a small amount of the nucleus pulposus and hence a reduction in the intradisc pressure and relief of radicular pain.

OBJECTIVES

To review of the literature and summarize the technical modalities, mechanism, indications for, and results of percutaneous laser disc decompression for treating lumbar disc herniation.

METHODS

We identified studies of percutaneous laser disc decompression published between January 1980 and June 2006 in the MEDLINE, EMBASE, and Cochrane Library databases. The search terms used were percutaneous laser disc decompression, laser, and spine or lumbar, disc or disk. The articles underwent a stepwise selection process on the basis of their title, abstract, and full text.

RESULTS

Experimental and clinical studies have investigated the modality of percutaneous laser disc decompression, but no consensus exists on the type of laser to use, the wavelength, duration of application, or appropriate energy applied. Studies have evaluated the impact of different techniques on the amount of disc removed, intradisc pressure, and damage to neighboring tissue. Several open studies have been published, but their methodology and conclusions are questionable, and no controlled study has been performed.

CONCLUSIONS

Although the concept of laser disc nucleotomy is appealing, this treatment cannot be considered validated for disc herniation-associated radiculopathy resistant to medical treatment.

Interventional radiology with laser in bone and joint

Laser energy is able to ablate, coagulate, and vaporize tissues. Its transmissibility in thin optical fibers makes it an ideal tool for use in percutaneous procedures. This article describes two applications in interventional musculoskeletal radiology. In percutaneous laser disc decompression the laser source is used to vaporize a small portion of the nucleus pulposus. In interstitial laser photocoagulation of osteoid osteoma the laser energy is used to coagulate and destroy the tumor by direct heating.