John M Mathis

Neuropathy Clinic Arm Unit

Most image-guided spine interventions are accomplished well with fluoroscopic guidance. It goes without saying that good visualization of the anatomical area being treated is necessary. Most modern fluoro-scopic equipment will provide this capability. It is important to view the target anatomy from multiple projections, and therefore a C-arm configuration is need. Fixed-plane fluoroscopic equipment commonly used for gastrointestinal work is not sufficient. The most sophisticated equipment in...

Vertebral Hemangiomas

Vertebral Hemangioma Mri

Vertebral hemangiomas are benign vascular malformations of the bone with a very well-known and well-described appearance on conventional radiography, computed tomography CT , and MRI. The incidence of hemangiomas is variable, depending on age, but has been reported to be around 11 with increasing age. Up to 30 of patients have multiple lesions. Pathologically, these hemangiomas are considered to be postcapil-lary vascular dysembryogenetic malformations. Microscopically, they are divided into...

Dural Arteriovenous Malformation Dorsal Intradural AVM or Type I

Progressive Congestive Myelopathy

The type I AVF represents the most common type of spinal vascular malformation and should be in the differential diagnosis in an adult presenting with gradually worsening myelopathy. This lesion, which Angiographic anatomic classification New classification Spetzler et al.1 Vascular malformations Epidural arteriovenous fistula Intradural pial arteriovenous fistula Hemangioblastoma Cavernous malformation Arteriovenous malformations Extradural intradural Type I subtypes A, B Type IV subtypes A,...

Classic Herniated Nucleus Pulposus HNP

Scan Hernia Nukleus Pulposus

APLD is efficacious only for patients whose herniations are still contained by the annulus or posterior longitudinal ligament, and this is the most important factor that has prevented the more widespread use of the procedure. Therefore effort must be expended to determine which patients are appropriate for this type of procedure. Magnetic resonance imaging MRI can be extremely helpful in excluding obviously migrated fragments and large disc extrusions. Herniations with smooth obtuse margins...

John C Oakley

Medtronic Intrathecal Pump

With the discovery that opioid drugs administered into the subarachnoid space could access spinal cord receptor sites and produce effective analgesia in malignant and nonmalignant pain syndromes, implanted drug delivery systems became a standard intervention for pain management. In 1979 Wang and colleagues reported that the use of morphine in cancer-related pain at doses of 0.5 to 1.0 mg resulted in excellent pain relief for 8 to 30 hours.1 Yaksh documented the physiological basis of the pain...

Recommended Technique for Spinal Angiography and Intervention

Lateral Sacral Branch

This brief overview of techniques and intervention is not intended to replace standard textbooks in this field. Generally speaking, contrary to popular opinion, with modern catheter techniques in the hands of trained physicians, spinal diagnostic workup should have no complications higher than that of a diagnostic angiography of the peripheral vascular system. Infrequently, minor asymptomatic iliac or aortic dissections may be encountered in patients with significant arteriosclerosis....

Diagnosis

Joint Ray Positioning

The diagnosis of SI joint pain is a diagnosis of exclusion. Other etiologies of pain such as spinal stenosis, herniated disc, and facet degenerative disease must first be excluded. Various physical maneuvers e.g., Patrick's test, Gillet test, Gaenslen's maneuver, pain with pressure application to the SI ligaments at the sacral sulcus with the patient prone have been described to diagnose SI joint pain3,16,31-32 but may be unreliable due to the lack of intraobserver and interobserver...

Artery Of Adamkiewicz

Metameric Vertebrae Development

Axial CT scans of three vertebrae. A Scan of a T11 vertebra demonstrates the sagittal configuration straight posterior to anterior of the pedicle with respect to the vertebral body. The line demonstrates the general tract that a needle would take during vertebroplasty by means of a transpedic-ular approach. In the scan of an L5 vertebra B , the transpedicular approach black line is nearly 45 away from the sagittal plane. In the scan at T1 C , the transpedicular angle with the...

Intradural Pial Arteriovenous Fistula Ventral Intradural AVF or Type IV

Pial Artery Spinal Artery

The type IV AVF represents a direct fistula from the anterior spinal artery to the coronal venous plexus Figure 16.2 . Radiculopial supply may also be involved. The intradural arteriovenous fistula has three subtypes, A, B, and C. These lesions can be seen anywhere along the spine. Subtype A also classified as Merland subtype I represents a small shunt, with moderate venous hypertension. There is no enlargement of the anterior spinal artery ASA and only minimal dilatation of the ascending...

Indications and Technique

Posterior Annular Fissure

IDET is indicated in the treatment of chronic, activity-limiting disco-genic low back pain that has been refractory to conservative measures and is generally characterized by 1. Function-limiting low back pain of at least 6 months' duration 2. Back pain greater than leg pain with no true radicular symptoms 3. Failure to improve significantly with a comprehensive nonoperative back care program including Progressive exercise physical therapy At least one fluoroscopic epidural injection A course...

Conclusions

Racz Adhesiolysis

Since their inception in 1985, release to the pain management community in 1987, and assignment of an CPT code in 2000, epidurography Figure 10.14. A Epidurogram demonstrating filling defect on right at the C7 nerve root level. B Cannulation of the right C7 medial neuroforamen. Figure 10.14. A Epidurogram demonstrating filling defect on right at the C7 nerve root level. B Cannulation of the right C7 medial neuroforamen. Figure 10.14. C Epidurolysis of the right C7 with transforaminal...

John M Mathis Ali Shaibani and Ajay K Wakhloo

Pedicle Lamina

The spine and its anatomical components are complex. Authors have approached it from a variety of perspectives including surgical, anatomical, and diagnostic imaging . Our interest in spinal anatomy concerns the treatment of pathological processes affecting the spine. This chapter describes spine anatomy that is of interest to the image-guided interventionist. The spine is composed of 33 bones there are 7 cervical vertebra, 12 thoracic vertebra, 5 lumbar vertebra, 5 sacral segments fused , and...