Ultrasound-guided interventions in primary carpal tunnel syndrome: perineural injection to thread carpal tunnel release.

Carpal tunnel syndrome (CTS), the most common entrapment neuropathy, is compression of the median nerve deep to transverse carpal ligament at wrist. Ultrasonography and electrophysiological study are complementary in the diagnosis and grading of CTS in appropriate clinical settings. The initial management of patients with CTS is conservative with medical therapy and splinting. However, surgical interventions are indicated in patients in whom medical management has failed. With evolution of the concept of safe zone on ultrasonography and identification of the sonoanatomical landmarks of carpal tunnel in greater detail, Ultrasonography-guided interventions are safer and preferred over surgical management in CTS. The primary ultrasonography-guided interventions include perineural injection, perineural hydrodissection and ultrasonography-guided release of transverse carpal ligament. This review article presents the principles of ultrasonography-guided perineural injection, perineural hydrodissection in CTS, the merits and demerits of injectant used in perineural injection/ hydrodissection, and percutaneous ultrasonography-guided thread release of transverse carpal ligament utilizing the concept of safe zone of the ultrasonography-guided interventions for CTS.

CT-guided radiofrequency ablation of osteoid osteoma: established concepts and new ideas.

Osteoid osteoma is a painful benign bone tumour of children and young adults with characteristic clinico-radiological features depending upon the location of the lesion. Intraoperative visualisation of the nidus is difficult and therefore curative surgery is often associated with excessive bone removal, significant perioperative morbidity and potential need of bone grafting procedures. With advancement in cross-sectional imaging and radiofrequency ablation (RFA) technology, CT-guided RFA has emerged as the treatment of choice for the osteoid osteoma. This procedure involves accurate cannulation of the nidus and subsequent thermocoagulation-induced necrosis.Multidisciplinary management approach is the standard of care for patients with osteoid osteoma. Appropriate patient selection, identification of imaging pitfalls, pre-anaesthetic evaluation and a protocol-based interventional approach are the cornerstone for a favourable outcome. Comprehensive patient preparation with proper patient position and insulation is important to prevent complications. Use of spinal needle-guided placement of introducer needle, namely, "rail-road technique" is associated with fewer needle trajectory modifications, reduced radiation dose and patient morbidity and less intervention time. Certain other procedural modifications are employed in special situations, for example, intra-articular osteoid osteoma and osteoid osteoma of the subcutaneous bone in order to reduce complications. Treatment follow-up generally includes radiographic assessment and evaluation of pain score. Dynamic contrast-enhanced MRI has been recently found useful for demonstrating post-RFA healing.

Approach-based techniques of CT-guided percutaneous vertebral biopsy.

Magnetic resonance imaging (MRI) plays an important role in the characterization of vertebral lesions. Even if latest improvements in MRI permit to understand and suspect the nature of vertebral lesions and positron emission tomography computed tomography (PET-CT) gives information about lesion metabolism, biopsy is still needed in most cases. CT-guided percutaneous vertebral biopsy is a minimally invasive, safe and accurate procedure for definitive tissue diagnosis of a vertebral lesion. CT-guided vertebral biopsy is often the best alternative to a surgical biopsy. The purpose of this technical note is to discuss the approach-based techniques for CT-guided percutaneous vertebral biopsy.

Recovering from nonspecific low back pain despair: Ultrasound-guided intervention in iliolumbar syndrome.

BACKGROUND: Iliolumbar syndrome is a frequent cause of chronic nonspecific low back pain. The cornerstone of its treatment lies upon the specific diagnosis of the iliolumbar syndrome. The ultrasound guided interventions have the potential for the specific diagnosis and treatment of the iliolumbar syndrome. OBJECTIVE: To assess the role of ultrasound-guided intervention for the diagnosis and treatment of the iliolumbar syndrome. MATERIALS AND METHODS: The study comprised of fifty-seven patients of nonspecific low back pain with the clinically suspected iliolumbar syndrome. Two-staged ultrasound-guided interventions were performed: Primary diagnostic and secondary therapeutic interventions. Favorable response after the injection of local anesthetic agent in iliolumbar ligament (defined as VAS score to ≥3) was classified as confirmed Ilio-lumbar syndrome. Clinico radiological efficacy after platelet-rich plasma (PRP) injection in confirmed iliolumbar syndrome patients was done. RESULTS: Out of 57 patients, 45 (78.95%) were diagnosed with confirmed Iliolumbar syndrome after primary diagnostic intervention. The mean value of VAS at presentation was 8.02 ± 0.72 which was decreased to 3.16 ± 1.63; P < 0.0001. All 45 patients underwent PRP injection in iliolumbar ligament and 42 patients (93.33%) showed reduction in mean VAS score from 8 ± 0.67 (at presentation) to 0.89 ± 1.23 after 6 weeks follow up; P < 0.0001. Iliolumbar ligament thickness was decreased from the day of presentation (2.66 ± 0.22) to 6 weeks after therapeutic intervention (0.91 ± 0.42); P < 0.0001. CONCLUSION: The ultrasound guided diagnostic and therapeutic intervention were found to result in a specific diagnosis and remarkable recovery in the iliolumbar syndrome group of nonspecific low back pain patients.