title: Real-time MR-guided lumbosacral periradicular injection therapy using an open 1.0-T MRI system: an outcome study.
abstract: OBJECTIVE
  The objective of this study was to evaluate the accuracy, safety, and efficacy of magnetic resonance (MR)-guided periradicular nerve root injection therapy using an open 1.0-T magnetic resonance imaging (MRI) system with fast dynamic imaging.
  
  
  METHODS
  Between April 2008 and November 2011, a total of 249 MR-guided periradicular nerve root injections were performed in 141 patients experiencing lumbosacral radicular pain. All interventions were performed in an open 1.0-T MRI system. An interactive proton-density-weighted fast spin-echo sequence was used for real-time guidance. An in-room monitor, a wireless MR mouse for operator-controlled multiplanar imaging, a flexible surface coil, and an MR-compatible 20-G needle were used. Informed consent was obtained from all patients. Clinical outcome was evaluated through clinical follow-up and a questionnaire before injection therapy (baseline) and 6 months after using a numeric visual analog scale.
  
  
  RESULTS
  All procedures were technically successful. No major complications occurred. At 6 months, of the 103 patients (197 injections; 57 men, 46 women; mean age, 49.5 years; range, 20-80) who enrolled in the outcome analysis, 14.6% reported complete remission of radicular pain; 53.4%, significant relief of pain; 22.3%, mild relief; and 9.7%, no relief of pain. We found a significant decrease of the visual analog scale score from the preintervention compared with the follow-up after 6 months (P < 0.001). No significant difference in the outcome was observed between the patients with degenerative foraminal stenoses and the patients with herniated disks.
  
  
  CONCLUSIONS
  Magnetic resonance fluoroscopy-guided periradicular injection therapy for the lumbosacral spine under open 1.0-T MRI guidance is accurate, safe, and efficient in the symptomatic treatment of radicular pain. This technique may be a promising alternative to fluoroscopy- or computed tomography-guided spinal injections in the lumbosacral region, especially for young patients and patients undergoing serial therapeutic regimens.
authors: Department of Radiology, Humboldt University of Berlin, Berlin, Germany. florian.streitparth@charite.de
authors: Florian
authors: F
authors: Streitparth
authors: Maximilian
authors: M
authors: De Bucourt
authors: Tony
authors: T
authors: Hartwig
authors: Tilman
authors: T
authors: Leidenberger
authors: Jens
authors: J
authors: Rump
authors: Thula
authors: T
authors: Walter
authors: Martin
authors: M
authors: Maurer
authors: Diane
authors: D
authors: Renz
authors: Lars
authors: L
authors: Stelter
authors: Edzard
authors: E
authors: Wiener
authors: Bernd
authors: B
authors: Hamm
authors: Ulf
authors: U
authors: Teichgräber
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000779:Anesthetics, Local / Q000008:administration & dosage; D000893:Anti-Inflammatory Agents / Q000008:administration & dosage; D002045:Bupivacaine / Q000008:administration & dosage*; D003199:Computer Systems; D004359:Drug Therapy, Combination / Q000379:methods; D005260:Female; D006801:Humans; D017116:Low Back Pain / Q000209:etiology / Q000517:prevention & control*; D008161:Lumbosacral Region / Q000473:pathology; D053783:Magnetic Resonance Imaging, Interventional / Q000379:methods*; D008297:Male; D008875:Middle Aged; D011843:Radiculopathy / Q000150:complications / Q000188:drug therapy* / Q000473:pathology*; D016896:Treatment Outcome; D014222:Triamcinolone Acetonide / Q000008:administration & dosage*; D055815:Young Adult
chemical_list: D000779:Anesthetics, Local; D000893:Anti-Inflammatory Agents; D014222:Triamcinolone Acetonide; D002045:Bupivacaine