Periradicular Therapy

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Position control of the PRT needle
Pain therapy on the open magnetic resonance tomograph at the Magdeburg University Hospital

A periradicular Therapy ( PRT ) is the percutaneous to an application of drugs locally nerve root (Radix) under the pain therapy of radicular pain, which is a nerve root can be assigned. A combination of a local anesthetic , which is supposed to numb the nerve, and a steroid , which has an anti-inflammatory and desensitizing effect , is usually injected.

Underlying theory

The causal pathology is circumscribed peripheral: there is an affection of the nerve root ( radiculopathy ). The injected drug acts on the target nerve root and thereby detects its afferent part (i.e. the back root).

indication

Above all, the PRT is a therapeutic measure for pain relief. It can also be used diagnostically (at the same time) to e.g. B. in atypical topographical conditions and / or multi-segment pathologies and monoradiculopathy (possibly oligoradiculopathy) to allow the determination of the affected nerve root (s) and, if necessary, the determination of the surgical area in a planned foraminotomy .

technology

The segment of the spine to be treated is set and imaged using X-ray fluoroscopy or computer tomography . Based on this, the doctor plans and controls the stitch direction and the stitch depth for the placement of the PRT needle. The PRT needle is placed after the skin has been disinfected and, if necessary, the puncture canal has been numbed locally. After checking the position with another image check and - optionally - the administration of some contrast medium, the medication is applied. Using anatomical landmarks, it is often possible to carry out the procedure without additional imaging procedures.

The treatment takes place in the prone or supine position and takes about ten minutes (with additional imaging, otherwise much shorter). The needle is inserted through the side of the neck when treating the nerve roots of the neck.

After the treatment, sensory disorders or even paralysis can occur in the part of the body supplied by the nerve root (e.g. one leg), so that the patient cannot walk alone for a few hours. However, in the vast majority of cases these effects are temporary.

Since 2007 the interventions have also been carried out in a few centers using an open magnetic resonance tomograph . The advantages here are the better soft tissue contrast, which allows easier positioning of the needle, and the non-existent radiation exposure from the computer tomograph (CT).

Possible complications and side effects

  • Contrast medium intolerance due to allergy or hyperthyroidism
  • Drug side effects from steroids (local therapy, therefore direct side effects are less pronounced; allergic reactions however possible)
  • Bleeding
  • infection
  • Nerve injury
  • Increase in symptoms after the 1st or 2nd therapy session
  • Paralysis
    • temporary paralysis (common)
    • temporary pronounced paralysis when inadvertently applied into the dural sac
    • permanent paralysis up to a paraplegia, z. B. after infection or hematoma formation (extremely rare)
  • No driving ability

Implementation as a cash benefit

According to the decision of the evaluation committee (290th meeting), the PRT may only be performed by certain doctors from April 1, 2013 in the usual variant with CT:

  • Doctors who themselves meet the requirements of the quality assurance agreement for pain therapy care of chronically pain-sick patients in accordance with Section 135 (2) SGB V or
  • to referral from doctors with these requirements or
  • on referral by doctors with the additional designation special pain therapy according to WBO.

This does not apply to analog procedures under fluoroscopy. Performing with the addition of corticosteroids is off-label and not covered by statutory health insurance.

literature

  • J. Hildebrandt: Relevance of nerve blocks in the diagnosis and therapy of back pain. Is the quality crucial? The pain 15 (6): 474-483, (2001).
  • Scanlon et al .: Cervical transforaminal epidural steroid injections: more dangerous than we think? Spine J 2007; 32: 1249-56

Individual evidence

  1. ↑ a b J. Stier: Secure PRT - expand orthopedic pain therapy. In: Orthopedics and Trauma Surgery - Messages and Messages. 02, 2013, p. 537, doi : 10.1055 / s-0033-1358407 .
  2. ↑ aerzteblatt.de