Zusammenfassung
Hintergrund
Der Erfolg einer Radiofrequenzablation (RF) des Ramus medialis rami dorsalis lumbalis bei Schmerzen aufgrund von Facettengelenksarthropathien ist abhängig von der effektiven Koagulationsstrecke. Bisherige Computertomographie(CT)-gesteuerte Techniken erreichen den Zielnerv nicht parallel, sondern nur punktuell. Wir beschreiben eine neue CT-gezielte Punktionstechnik, um die Parallelität und Nähe der RF-Thermoläsionsnadel zum Nerv zu verbessern.
Material und Methoden
Zwei Untersucher mit unterschiedlicher Punktionserfahrung mit Bildgebung führten an 10 Leichen die Untersuchung auf je einer Leichenseite durch. Eine RF-Thermoläsionsnadel wurde 1 cm lateral des Processus spinosus des nächsten kaudal liegenden Wirbels in Bezug auf den zu erreichenden Zielnerv eingestochen. Die Nadel wurde in einem flachen Winkel CT-gesteuert zwischen Processus articularis superior und Basis des Processus costalis des kranial gelegenen Wirbels positioniert und die Nadelposition durch Dissektion verifiziert. Als „erfolgreich durchgeführt“ wurde definiert, wenn die Nadel mit maximal einem Korrekturversuch in der Zielposition platziert werden konnte.
Ergebnisse
Von 100 möglichen Punktionen (50 pro Seite) an den 5 lumbalen Segmenten konnten die RF-Nadeln nach maximal einer Nadelkorrektur in 86 Fällen CT-morphologisch im Zielgebiet dargestellt werden. Die anatomischen Dissektionen zeigten, dass 47 von 86 positionierten RF-Nadeln (54,6 %) die Anforderung einer maximalen Parallelität und Nähe zum Nerv erfüllten. Der Ramus dorsalis der lumbalen Spinalnerven wurde in keinem Fall mit der RF-Nadel erreicht. Am niedrigsten war die Erfolgsrate in den Übergangssegmenten L1-L2 und L5-S1.
Diskussion
Mittels der hier beschriebenen Technik wird das Prinzip der Parallelität und Nähe der Nadelpositionierung zum Nerv erfüllt. Die Nadelpositionierung erfordert aufgrund der schrägen Punktionsrichtung Übung.
Abstract
Background
The success of radiofrequency ablation (RF) of the medial branch of the dorsal ramus in patients with facet joint pain depends on the effective coagulation distance. To date, computed tomography(CT)-guided techniques do not reach the nerve in parallel but rather than punctually. We report a new CT-guided technique to enhance parallelism and proximity of the RF needle to the nerve.
Materials and methods
Two examiners with different experience with CT-guided procedures in corpses performed all punctures at the lumbar spine on 10 corpses. A RF needle was inserted 1 cm lateral to the spinous process of the vertebra located caudal to the target nerve. The needle was advanced under CT guidance at a flat angle between the superior articular process and the base of the costal or transverse process of the cranial vertebra. The position was verified by dissection. Needle position was judged successful provided the needle could be positioned in the first attempt with no more than one angle correction.
Results
In 86 out of 100 possible cases (50 per side) at the 5 lumbar segments, the RF needle could be depicted by CT in the target area with no more than one correction of the needle position. Anatomical dissections revealed that 47 out of 86 needles (54.6%) fulfilled the requirements of parallelism and proximity to the nerve. The dorsal ramus was never reached by the RF needle. Higher success rates were obtained in the middle segments compared to the border segments of L1–L2 and L5–S1.
Conclusions
We could demonstrate that the principle of parallelism and proximity of the needle to the nerve could be fulfilled with this new technique; however, needle positioning requires practice due to the oblique puncture direction.
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G.C. Feigl, C. Mattersberger, W. Rosmarin, R. Likar und C. Avila González geben an, dass kein Interessenkonflikt besteht.
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Feigl, G.C., Mattersberger, C., Rosmarin, W. et al. Lumbale CT-gezielte Radiofrequenzablationen des Ramus medialis rami dorsalis nervi spinalis. Schmerz 32, 99–104 (2018). https://doi.org/10.1007/s00482-018-0283-9
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DOI: https://doi.org/10.1007/s00482-018-0283-9
Schlüsselwörter
- Facettengelenksschmerz
- Radiofrequenzablation
- Thermokoagulation
- Lumbale Facettengelenksdenervation
- Lumbaler Ramus medialis