First Announcement-Call for paperFirst Announcement-Call for paper……………………………………………………Tehran, 5-7 May 2005Tehran, 5-7 May 2005

Minimally Interventional Minimally Interventional Spinal TreatmentSpinal Treatment

The FirstThe First

International Congress on theInternational Congress on the

•Basic sciences & EpidemiologyBasic sciences & Epidemiology

•Non-invasive managementNon-invasive management

•Minimally invasive managementMinimally invasive management

•Rehabilitation medicineRehabilitation medicine

Jalal Jalal Shokouhi-M.D.Interventional RadiologyInterventional C.T.Interventional therapy : MicrotherapyFacet and peri-Radicular therapy

jalaljalalshokouhi@hotmail.comjalaljalalshokouhi@hotmail.com

Interventional Computed TomographyInterventional Computed Tomography

Rainer M.M. Seibel,M.D. , PhD. &Rainer M.M. Seibel,M.D. , PhD. &

Dietrich H.W. Gronemeyer, M.D , PhD.Dietrich H.W. Gronemeyer, M.D , PhD.DirectorsInstitute of Diagnostic & Interventional RadiologyMedical computer sciencePrivate University of Witten/HerdeckeMRI – Mulheim Radiologic institute ,Germany

Microtherapy

Micro endoscopy

ADVANTAGES OF ADVANTAGES OF CT GUIDANCECT GUIDANCE

PUNCTURE ACCURACY 1mmPUNCTURE ACCURACY 1mm33

NO INJURIES OF NERVE ROOT, AORTA , A.ILIACA NO INJURIES OF NERVE ROOT, AORTA , A.ILIACA OR OTHER NEAR STRUCTURESOR OTHER NEAR STRUCTURES

CONTROL OF NUCLEOTOMYCONTROL OF NUCLEOTOMY

PERCUTANEOUS NUCLEOTOMYPERCUTANEOUS NUCLEOTOMY

IF YOU GOT A NEW HAMMEREVERYTHING LOOKS LIKE A NAIL

GARY ONIK

ACUTE SCIATIC PAINACUTE SCIATIC PAIN

ANTIPHLOGISTICS COOL POSITION

CHRONIC SCIATIC PAINCHRONIC SCIATIC PAIN

ANTIPHLOGISTICS WARM SWIMMING BACK SCHOOL MUSCLE TRAINING

THERAPY PLAN FOR LUMBAGOTHERAPY PLAN FOR LUMBAGOCONSERVATIVE THERAPY UP TO 4 WEEKSCONSERVATIVE THERAPY UP TO 4 WEEKS

X ray L spineCT L spine

1.PRT

2.FACETTE BLOCKADE / DENERVATION

3.SURGERY

THERAPY PLAN FOR SCIATIATHERAPY PLAN FOR SCIATIAWITHOUTWITHOUT WEAKNESSWEAKNESS

CONSERVATIVE THERAPY UP TO 2 WEEKSCONSERVATIVE THERAPY UP TO 2 WEEKS

X ray L spine CT L spine

NO ACCESS/ RECURRENCE MRI

1.PRT

2.PERCUTANEOUS NUCLEOTOMY

3.SURGERY

THERAPY PLAN FOR SCIATIATHERAPY PLAN FOR SCIATIAWITH WITH WEAKNESSWEAKNESS IMMEDIATLY IMMEDIATLY

X ray L spine , CT L spine and MRI

THERAPY IN THE HOSPITAL

1.SURGERY

2.SUBACUTE: PRT

MICROTHERAPY

PERIRADICULAR THERAPYPERIRADICULAR THERAPY

Periradicular Theraphy (PRT)Periradicular Theraphy (PRT)

MICROTHERAPY

FACETTE DENERVATIONFACETTE DENERVATION

INDICATIONS OF PRTINDICATIONS OF PRT FAILED BACK SURGERYFAILED BACK SURGERY HERNIATION OF DISKHERNIATION OF DISK PROTRUSIONPROTRUSION NERVE ROOT COMPRESSION WITH NERVE ROOT COMPRESSION WITH

WEAKNESS OR SENSIBLE LOSSWEAKNESS OR SENSIBLE LOSS SPINAL CANAL STENOSISSPINAL CANAL STENOSIS FORAMINAL STENOSISFORAMINAL STENOSIS LATERAL RECESSUS STENOSISLATERAL RECESSUS STENOSIS

LOCALISATION OF PRTN=370

Lumbar spine 221 59,7%Lumbar spine 221 59,7%

Thoracical spine 16 4,3%Thoracical spine 16 4,3%

Cervical spine 133 36,0%Cervical spine 133 36,0%

PAINFREE AFTER PRTN=370

Lumbar spine 80%Lumbar spine 80%

Thoracical spine 82%Thoracical spine 82%

Cervical spine 74%Cervical spine 74%

PERIRADICULAR THERAPY (PRT)PERIRADICULAR THERAPY (PRT)Results prospective randomized studyResults prospective randomized study

FREE OF PAIN AFTER THERAPYFREE OF PAIN AFTER THERAPY

VOLON A 40 mg 80%VOLON A 40 mg 80%

VOLON A 10 mg 55%VOLON A 10 mg 55%

( triamcinolonacetonid)( triamcinolonacetonid)

N=100

SIDEEFFECTS AFTER PRTN=370

Cramp in the calf 8%Cramp in the calf 8%

Weight increase 8%Weight increase 8%

Acne 4%Acne 4%

Edema 3%Edema 3%

Segmental pain 3%Segmental pain 3%

Petechia 0,5%Petechia 0,5%

Hormonal disorder (Hormonal disorder (5 of 1705 of 170)) 3%

RESULTS AFTER PRTRESULTS AFTER PRTN=370N=370

Painfree at the end of therapy 78%Painfree at the end of therapy 78%

Painfree 3 months after therapy 83%Painfree 3 months after therapy 83%

Painfree 2 years after therapy (Painfree 2 years after therapy (n=78n=78) 68%) 68%

Second operation at the same level 3,2%Second operation at the same level 3,2%

Surgery of spine

70-80% Good70-80% Good

20-30% Bad20-30% Bad

50-60% Good50-60% Good

40% Poor40% Poor

MicrotherapyMicrotherapy

8 times “6 months”8 times “6 months”

Every 3 weeksEvery 3 weeksDrugs: PRT=Drugs: PRT=Marcain , CortonMarcain , Corton , FT= , FT=Ethanol, MarcainEthanol, Marcain

First , Next injectionsFirst , Next injections

2-7 sessions 2-7 sessions

Facets Ethanol, MarcainFacets Ethanol, Marcain

Epidural Marcain, CortonEpidural Marcain, Corton

Tria. ~40mg depomedrolTria. ~40mg depomedrol

Tria.~ 80mg depomedrolTria.~ 80mg depomedrol

Complications

Minor: Leg muscle cramp, Acnea3 cases : collapsed vital signs1 cases : staphylococus areasRepeated treatments ~7 patients

Results from 1992 to 2004Results from 1992 to 2004

1800 patients

1402 Male

398 Female

-pain free 85% in 93% patients-pain free 85% in 93% patients

Spondylolysthesis 50% pain free

-back to work = all patients-back to work = all patients

- All treatments requested by other physicians- All treatments requested by other physicians

Thank you for Thank you for your attentionyour attention