CT-guided injection:
Diagnostics and therapy
Introduction
The human spine contains 24 vertebrae and 23 intervertebral discs. The spinal nerves run in the spinal canal and branch off to the nerves of the peripheral nervous system in the arms, legs and organs. Intervertebral discs act as shock absorbers for the spine. They sit between the individual vertebrae and prevent them from rubbing against each other. If the buffer does not work properly, back pain and restricted movement can occur.
In a healthy adult, the average height of the intervertebral discs is approximately 5 to 13 mm. Due to the fact that the intervertebral discs of the lumbar spine are subjected to greater stress than those of the cervical spine, they have a stronger structure and are therefore more than twice as high. The height and water content of the intervertebral discs generally decrease with age and over the course of a day.
An intervertebral disc is divided into two anatomical parts:
External circular fibrous ring (annulus fibrosus)
Internal gelatinous core (nucleus pulposus)
The spine is subjected to continuous movement and impact during physical exertion. A young intervertebral disc is able to withstand forces of 800 N/m2. The intervertebral discs ensure that the pressure is evenly distributed across the entire surface of the adjacent vertebral body end plates. This effect is particularly important in the case of one-sided loads in order to prevent pressure peaks on individual end plate areas.
Herniated disc
When a disc herniates, the tissue of the disc between the vertebral bodies is pushed outwards more and more. Symptoms arise when the bulging disc or protruding tissue presses on a nerve root or nerve. The more the nerve root is compressed, the more severe the symptoms are.
Often, disc damage is caused by years of wear and tear or poor posture without any pain. Then a trigger is enough to bring about the symptoms: a clumsy movement, a sudden twisting of the spine, drafts, dampness, hypothermia, etc. Sudden shooting pain is typical, colloquially known as "lumbago". If nerve structures are trapped by large parts of the disc, sensory disturbances and loss of strength, even paralysis, can also occur.
Depending on the degree of damage to the intervertebral disc, the following forms are distinguished:
Disc protrusion: The disc bulges between the vertebral bodies. The disc's shell is intact.
Herniated disc (extrusion): The outer shell of the disc is torn and the inner core bulges outwards.
Sequestered disc herniation (sequestrum): Tissue from the disc has protruded through the torn sheath into the spinal canal.
Diagnostics
The gold standard for diagnosing herniated discs and spinal stenosis is magnetic resonance imaging (MRI). This allows the anatomical structures to be displayed in high resolution and a reliable diagnosis to be made.
The MRI is also used to plan the CT-targeted infiltration we perform with millimeter precision. Our patients usually bring the MRI examination on a data storage device to our practice and we then explain the images or plan the procedure. Alternatively, we organize an MRI for our patients.
The MRI of the lumbar or cervical spine takes about 15 minutes and does not contain any harmful X-rays. As radiologists, we are qualified by our training and professional standards to diagnose and interpret these examinations.
Therapy
We and our patients have had the best experience with CT (computer tomography) targeted infiltration in the gentle and effective treatment of herniated discs, spinal canal stenosis and facet joint arthrosis.
The advantage of this minimally invasive intervention is that the medication is administered precisely to the area causing the pain by precisely positioning the infiltration needle.
For this purpose, we have developed a tailor-made and tried-and-tested drug mixture of glucocorticoids (anti-inflammatory and decongestant effects) and local anesthetics (pain-relieving effects) with long-term effects.
We can thus achieve rapid pain relief and reduction of swelling in cases of herniated discs, spinal canal stenosis (narrowing of the spinal canal) and facet joint arthrosis.