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Real-Time MR-Guided Lumbosacral Periradicular Injection Therapy Using an Open 1.0-T MRI System: An Outcome Study

Streitparth, Florian MD*; De Bucourt, Maximilian MD*; Hartwig, Tony MD; Leidenberger, Tilman MD*; Rump, Jens MD*; Walter, Thula MD*; Maurer, Martin MD*; Renz, Diane MD*; Stelter, Lars MD*; Wiener, Edzard MD*; Hamm, Bernd MD*; Teichgräber, Ulf MD*

doi: 10.1097/RLI.0b013e31828362be
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Objectives The objective of this study was to evaluate the accuracy, safety, and efficacy of magnetic resonance (MR)–guided periradicular nerve root injection therapy using an open 1.0-T magnetic resonance imaging (MRI) system with fast dynamic imaging.

Materials and Methods Between April 2008 and November 2011, a total of 249 MR-guided periradicular nerve root injections were performed in 141 patients experiencing lumbosacral radicular pain. All interventions were performed in an open 1.0-T MRI system. An interactive proton-density-weighted fast spin-echo sequence was used for real-time guidance. An in-room monitor, a wireless MR mouse for operator-controlled multiplanar imaging, a flexible surface coil, and an MR-compatible 20-G needle were used. Informed consent was obtained from all patients. Clinical outcome was evaluated through clinical follow-up and a questionnaire before injection therapy (baseline) and 6 months after using a numeric visual analog scale.

Results All procedures were technically successful. No major complications occurred. At 6 months, of the 103 patients (197 injections; 57 men, 46 women; mean age, 49.5 years; range, 20–80) who enrolled in the outcome analysis, 14.6% reported complete remission of radicular pain; 53.4%, significant relief of pain; 22.3%, mild relief; and 9.7%, no relief of pain. We found a significant decrease of the visual analog scale score from the preintervention compared with the follow-up after 6 months (P < 0.001). No significant difference in the outcome was observed between the patients with degenerative foraminal stenoses and the patients with herniated disks.

Conclusions Magnetic resonance fluoroscopy–guided periradicular injection therapy for the lumbosacral spine under open 1.0-T MRI guidance is accurate, safe, and efficient in the symptomatic treatment of radicular pain. This technique may be a promising alternative to fluoroscopy- or computed tomography–guided spinal injections in the lumbosacral region, especially for young patients and patients undergoing serial therapeutic regimens.

Supplemental digital content is available in the text.

From the *Department of Radiology, and †Center for Musculoskeletal Surgery, Charité, Humboldt University of Berlin, Berlin, Germany.

Received for publication June 5, 2012; and accepted for publication, after revision, December 6, 2012.

Conflicts of interest and sources of funding: none declared.

Florian Streitparth, MD and Maximilian De Bucourt, MD contributed equally.

Supplemental digital contents are available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal’s Web site (www.investigativeradiology.com).

Reprints: Florian Streitparth, MD, Department of Radiology, Charité, Humboldt University Medical School, Charitéplatz 1, 10117 Berlin, Germany. E-mail: florian.streitparth@charite.de.

© 2013 by Lippincott Williams & Wilkins