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Failed Back Syndrome Therapy

Failed Back Syndrome Therapy. Jalal Jalal Shokouhi –MD Iranian Society of Radiology Secretary Shahid Beheshti & Azad university Ali Akbar Ameri –MD* Hamid Mohammad pour –MD* Hamidreza Edraki –MD* *Shahid Beheshti Med. Univ. Iran. Jalaljalalshokouhi@hotmail.com.

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Failed Back Syndrome Therapy

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  1. Failed Back Syndrome Therapy Jalal Jalal Shokouhi –MD Iranian Society of Radiology Secretary Shahid Beheshti & Azad university Ali Akbar Ameri –MD* Hamid Mohammad pour –MD* Hamidreza Edraki –MD* *Shahid Beheshti Med. Univ. Iran Jalaljalalshokouhi@hotmail.com

  2. CT GUIDANCE Benefits:Pain reduction Back to work PRT : Periradicular therapy FT : Facet therapy I.S : Intra spinal (intratechal) Sympatectomy : Causalgia * All patients with back school

  3. Male 2496 2800 patients 1993 to 2007 Failed back syndrome in 1947 Requested by: Neurosurgeons, Orthopedic surgeons, Neurologists, Few other spe. Like internists, cariopractices Female 304

  4. Pain control 3,6,12 and 24 months Pain free or low pain 85% Repeat treatment after 1 year therapy 8 patients Repeat treatment more than 4 years 3 patints Spondylolystesis 50% pain free

  5. Drugs: • Corticosteroid 40-80 Mg. • Bupivicain 0.5% • Ethanol 65% for FT & Sympatectomy • 0.5 cc Iodine contrast or air for localization

  6. Complications: Minor * Leg Acnea (triamecinolon acetonid, Depomedrol) Major * 3 cases during IS, respiratory distress and collaps due to canal stenosis and local anesthesia migration upward. **one case of staph. septicemia in a hospitallized case ***No mortality

  7. Interventional Computed Tomography Rainer M.M. Seibel,M.D. , PhD. & Dietrich H.W. Gronemeyer, M.D , PhD. Directors Institute of Diagnostic & Interventional Radiology Medical computer science Private University of Witten/Herdecke MRI – Mulheim Radiologic institute ,Germany

  8. ADVANTAGES OF CT GUIDANCE • PUNCTURE ACCURACY 1mm3 • NO INJURIES OF NERVE ROOT, AORTA , A.ILIACA OR OTHER NEAR STRUCTURES • CONTROL OF NUCLEOTOMY

  9. MICROTHERAPY PERIRADICULAR THERAPY

  10. Periradicular Theraphy (PRT)

  11. MICROTHERAPY FACETTE DENERVATION

  12. INDICATIONS OF PRT • FAILED BACK SURGERY • HERNIATION OF DISK • PROTRUSION • NERVE ROOT COMPRESSION WITH WEAKNESS OR SENSIBLE LOSS • SPINAL CANAL STENOSIS • FORAMINAL STENOSIS • LATERAL RECESSUS STENOSIS

  13. Thank you for your attention

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