Library of Congress Cataloging-in-Publication Data Mathis, John M.

Image-guided spine interventions / John M. Mathis.

p. cm. Includes index.

ISBN 0-387-40320-5 (alk. paper)

1. Spine—imaging. 2. Spine—Surgery. 3. Surgery—Data processing. I. Title. RD768.M388 2003

617.5'6-dc21 2003052966

ISBN 0-387-40320-5 Printed on acid-free paper.

© 2004 Springer-Verlag New York, Inc.

All rights reserved. This work may not be translated or copied in whole or in part without the written permission of the publisher (Springer-Verlag New York, Inc., 175 Fifth Avenue, New York, NY 10010, USA), except for brief excerpts in connection with reviews or scholarly analysis. Use in connection with any form of information storage and retrieval, electronic adaptation, computer software, or by similar or dissimilar methodology now known or hereafter developed is forbidden.

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Printed in the United States of America.

Springer-Verlag New York Berlin Heidelberg A member of BertelsmannSpringer Science +Business Media GmbH

To the women in my life who make all things possible: Krista, Jamie, Juanita, Jean, Ida, Mildred, and Vernice.

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The field of interventional radiology is constantly undergoing change, and its procedures evolve over time. There is currently tremendous pressure on our specialty, as cardiology and vascular surgery appropriate existing vascular interventions. We need to be looking constantly for new procedures that will replace this loss. In the 1980s, the introduction of vascular access provided new procedures that included the placement of temporary venous catheters, ports, tunneled catheters, and dialysis maintenance. As a result of vascular access the number of procedures performed in some interventional labs doubled. The same revolution is occurring again with the advent of image-guided spine intervention. Five percent of the American population at any one time has back pain. This huge patient population is seeking help for this disabling and persistent problem.

Image-Guided Spine Interventions describes the varied and numerous procedures that are available to the image-guided interventionist, who may provide these therapies for the spine. This book embraces clinical evaluation, pharmacological requirements, procedural recommendations, and a spectrum of procedures that will be of interest to the image-guided spine interventionist. It covers a broad range of material that is presented by experts in each field, including discography, intradiscal electrothermal therapy (IDET), percutaneous discectomy, vertebroplasty and ballon kyphoplasty, epidural steroid injections, selective nerve root blocks and autonomic nerve blockade, diagnostic epidurography and therapeutic epidurolysis, sacroiliac and facet joint injections, implanted drug delivery systems, and epidural blood and fibrin patches for CSF leaks. Some of the techniques described, such as ozone therapy are expected to evolve further in the next decade. This book will be useful to all physicians who deal with back pain, including pain anesthesiologists, spine neurosurgeons, orthopedists, and radiologists.

As a previous president of the American Society of Spine Radiology and as a physician who has worked to develop image-guided spine intervention in academic and clinical practice, my entire practice is now devoted to providing these interventions. My clinical practice has more than doubled because of the introduction of these spine procedures. This is the next huge opportunity for the image-guided interventional community. I sincerely hope this work will be useful in helping you establish and grow a minimally invasive spine interventional practice. It has been a rewarding area for me.


Preface vii Contributors xi

1 Spine Anatomy 1

John M. Mathis, Ali Shaibani, and Ajay K. Wakhloo

2 Materials Used in Image-Guided Spine Interventions 27

John M. Mathis

3 Patient Evaluation and Criteria for Procedure Selection 37

Paul J. Christo and Peter S. Staats

4 The Surgeon's Perspective: Image-Guided Therapy and Its Relationship to Conventional Surgical Management 53

F. Todd Wetzel and Frank M. Phillips

5 Image-Guided Percutaneous Spine Biopsy 69

A. Orlando Ortiz and Gregg H. Zoarski

6 Discography 94

Kurt P. Schellhas

7 Intradiscal Electrothermal Annuloplasty 121

Timothy S. Eckel

8 Automated Percutaneous Lumbar Discectomy in the Treatment of Herniated Discs 137

Gary Onik and Wendell A. Gibby

9 Epidural Steroid Injections and Selective Nerve Blocks 149

Blake A. Johnson

10 Diagnostic Epidurography and Therapeutic Epidurolysis 171

K. Dean Willis

11 Facet Joint Injections 203

Timothy S. Eckel

12 Autonomic Nerve Blockade 219

Wade Wong and John M. Mathis

13 Sacroiliac Joint Injection 234 M.J.B. Stallmeyer and Gregg H. Zoarski

14 Percutaneous Vertebroplasty 245

John M. Mathis

15 Implanted Drug Delivery Systems 273

John C. Oakley

16 Endovascular Therapy of the Spine 292

Ali Shaibani and Ajay K. Wakhloo

17 Epidural Blood and Fibrin Patches 322 Lisa Watanabe

18 Balloon Kyphoplasty 334

John M. Mathis, Wayne J. Olan, and Stephen M. Belkoff

19 Intradiscal Oxygen-Ozone in the Treatment of Herniated Lumbar Disc 349

Mario Muto, Cosma Andreula, and Marco Leonardi

Index 359

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