title: MR guidance and thermometry of percutaneous laser disc decompression in open MRI: an initial clinical investigation.
abstract: OBJECTIVE
  To assess the feasibility, safety and efficacy of real-time MR guidance and thermometry of percutaneous laser disc decompression (PLDD).
  
  
  METHODS
  Twenty-four discs in 22 patients with chronic low-back and radicular pain were treated by PLDD using open 1.0-T magnetic-resonance imaging (MRI). A fluoroscopic proton-density-weighted turbo spin-echo (PDw TSE) sequence was used to position the laser fibre. Non-spoiled gradient-echo (GRE) sequences were employed for real-time thermal monitoring based on proton resonance frequency (PRF). Radicular pain was assessed over 6 months with a numerical rating scale (NRS).
  
  
  RESULTS
  PLDD was technically successful in all cases, with adequate image quality for laser positioning. The PRF-based real-time temperature monitoring was found to be feasible in practice. After 6 months, 21 % reported complete remission of radicular pain, 63 % at least great pain relief and 74 % at least mild relief. We found a significant decrease in the NRS score between the pre-intervention and the 6-month follow-up assessment (P < 0.001). No major complications occurred; the single adverse event recorded, moderate motor impairment, resolved.
  
  
  CONCLUSIONS
  Real-time MR guidance and PRF-based thermometry of PLDD in the lumbar spine under open 1.0-T MRI appears feasible, safe and effective and may pave the way to more precise operating procedures.
  
  
  CONCLUSIONS
  • Percutaneous laser disc decompression (PLDD) is increasingly used instead of conventional surgery. • Open 1.0-T MRI with temperature mapping seems technically successful in monitoring PLDD. • Pain relief was at least 'great' in 64 % of patients. • No major complications occurred. • Open 1.0-T MRI appears a safe and effective option for patient-tailored PLDD.
authors: Department of Radiology, Charité, Humboldt-University Medical School, Charitéplatz 1, 10117, Berlin, Germany, florian.streitparth@charite.de.
authors: Florian
authors: F
authors: Streitparth
authors: Tony
authors: T
authors: Hartwig
authors: Thula
authors: T
authors: Walter
authors: Maximilian
authors: M
authors: De Bucourt
authors: Michael
authors: M
authors: Putzier
authors: Patrick
authors: P
authors: Strube
authors: Tina
authors: T
authors: Bretschneider
authors: Patrick
authors: P
authors: Freyhardt
authors: Martin
authors: M
authors: Maurer
authors: Diane
authors: D
authors: Renz
authors: Bernhard
authors: B
authors: Gebauer
authors: Bernd
authors: B
authors: Hamm
authors: Ulf K M
authors: UK
authors: Teichgräber
mesh_terms: D000328:Adult; D019299:Decompression, Surgical / Q000379:methods*; D005260:Female; D006801:Humans; D007405:Intervertebral Disc Displacement / Q000473:pathology* / Q000601:surgery*; D053685:Laser Therapy / Q000379:methods*; D008159:Lumbar Vertebrae / Q000601:surgery; D008279:Magnetic Resonance Imaging / Q000379:methods*; D008297:Male; D008875:Middle Aged; D064847:Multimodal Imaging / Q000379:methods; D010865:Pilot Projects; D025321:Surgery, Computer-Assisted / Q000379:methods*; D013817:Thermography / Q000379:methods*
references: Bull World Health Organ. 2003;81(9):671-6
references: 14710509
references: Eur Radiol. 1998;8(4):592-7
references: 9569329
references: BMC Musculoskelet Disord. 2009 May 13;10:49
references: 19439098
references: Photomed Laser Surg. 2012 Feb;30(2):92-5
references: 22150064
references: Radiographics. 1996 Jan;16(1):89-96
references: 10946692
references: Acta Neurochir Suppl. 2011;108:117-21
references: 21107947
references: Semin Arthritis Rheum. 2007 Aug;37(1):20-30
references: 17363041
references: AJR Am J Roentgenol. 2009 Apr;192(4):W161-7
references: 19304676
references: Spine (Phila Pa 1976). 2007 Jul 15;32(16):1735-47
references: 17632394
references: Lancet. 1999 Aug 14;354(9178):581-5
references: 10470716
references: Eur Radiol. 2013 Jun;23(6):1487-94
references: 23314597
references: Photomed Laser Surg. 2004 Oct;22(5):431-3
references: 15671718
references: J Bone Joint Surg Am. 2006 Apr;88 Suppl 2:3-9
references: 16595435
references: Spine (Phila Pa 1976). 1987 Apr;12(3):287-94
references: 2954226
references: Cardiovasc Intervent Radiol. 2010 Apr;33(2):346-51
references: 19705200
references: J Magn Reson Imaging. 2010 Jun;31(6):1499-503
references: 20512906
references: Eur Radiol. 2010 Feb;20(2):395-403
references: 19727752
references: Photomed Laser Surg. 2006 Dec;24(6):694-7
references: 17199468
references: J Clin Laser Med Surg. 2003 Jun;21(3):131-8
references: 12828847
references: Eur Radiol. 2002 Jun;12(6):1331-7
references: 12042935
references: Surg Neurol. 2007 Aug;68(2):159-63
references: 17662349
references: Photomed Laser Surg. 2004 Oct;22(5):418-22
references: 15671715
references: Eur Radiol. 2011 May;21(5):1043-9
references: 21116633
references: Pain Physician. 2009 Jul-Aug;12(4):699-802
references: 19644537
references: Am J Orthop (Belle Mead NJ). 1996 Dec;25(12):825-8
references: 9001678
references: J Clin Laser Med Surg. 2001 Feb;19(1):15-20
references: 11547813
references: Int J Hyperthermia. 2010;26(4):295-304
references: 20210604
references: Photomed Laser Surg. 2004 Oct;22(5):407-10
references: 15671713
references: Pain Physician. 2009 Jul-Aug;12(4):E35-70
references: 19668291
references: Pain Physician. 2009 May-Jun;12(3):573-88
references: 19461824