Abordaje intervencionista del síndrome facetario lumbar: denervación con radiofrecuencia / Interventional approach for lumbar facet syndrome: radio frequency denervation

Lumbar pain is a common and frequent chronic condition. It is estimated that facet joint pain represents 15-31% of all consultations for low back pain. In suspected facet joint pain, it is recommended to perform nerve blocks to establish the diagnosis. Percutaneous continuous radiofrequency is the most effective treatment to date. We describe the current evidence on the minimally invasive treatment of lumbar facet syndrome and our experience with image guidance with CT and fluoroscopy by means of rhizolysis of the medial branch of the dorsal primary ramus of the spinal nerve.

El dolor lumbar es una entidad común y frecuente crónica. Se estima que el dolor de causa articular facetaria representa el 15-31% de todas las consultas por dolor lumbar. En sospecha de dolor articular facetario se recomienda realización de bloqueos nerviosos para establecer el diagnóstico. La radiofrecuencia continua percutánea es el tratamiento más efectivo hasta la fecha. Se describe la evidencia actual en el tratamiento mínimamente invasivo del síndrome facetario lumbar y nuestra experiencia con las guías de imagen con TC y fluoroscopía mediante rizolisis de la rama medial del ramo primario dorsal del nervio espinal.

Comparison of ultrasound and fluoroscopic guidance for injection in CT arthrography and MR arthrography of the hip. / Comparación de las técnicas de inyección ecográfica y radioscópica en artro-TC y artro-RM de cadera.

OBJECTIVE: To evaluate the usefulness of ultrasound-guided versus fluoroscopy-guided injection in CT arthrography and MR arthrography. MATERIAL AND METHODS: We reviewed all CT arthrography and MR arthrography studies done at our center between October 1, 2014 and October 1, 2015. We analyzed 32 studies: 26 with fluoroscopic guidance and 6 with ultrasound guidance. We compared the two techniques on the following parameters: presence of sufficient contrast material in the joint, extravasation or injection of contrast material in the soft tissues (presence of contrast material in the psoas or other soft tissues), and intra-articular gas bubbles. We used SPSS V. 20 to compare the techniques with Pearson's chi-square tests. RESULTS: Contrast material was observed in soft tissues in 56.3% of ultrasound-guided injections, making 6.3% of the procedures invalid for diagnostic purposes. Extravasation of contrast material was observed in 53.8% of fluoroscopy-guided procedures, making 3.8% invalid for diagnostic purposes. Intra-articular gas was observed in 21.9% of ultrasound-guided studies and in 38.5% of fluoroscopy-guided studies. None of the differences between techniques were statistically significant at p<0.05. CONCLUSIONS: Our study shows that ultrasound is as useful as fluoroscopy for injecting contrast material for CT arthroscopy and MR arthroscopy; ultrasound has the advantage of not using ionizing radiation.

[Applications of multidetector computed tomography in limb trauma]. / Aplicaciones de la tomografía computarizada multidetector en la patología traumática de las extremidades.

Multidetector computed tomography (MDCT) has significant advantages over plain-film X-rays in the study of the extremities. Acute trauma poses diagnostic challenges, especially in joints in which the overlapping of bony structures impedes the view of the fractures or luxations. Each major joint has at least one classification system for fractures that aims to include the fundamental aspects necessary to orient the most effective treatment. These are the cases in which MDCT's capabilities for multiplanar and three-dimensional reconstructions provide information that is crucial for the management of trauma to the joint.

Aplicaciones de la tomografía computarizada multidetector en la patología traumática de las extremidades / Applications of multidetector computed tomography in limb trauma

La tomografía computarizada multidetector (TCMD) ofrece significativas ventajas frente a la radiología simple en el estudio de las extremidades. El traumatismo agudo plantea desafíos diagnósticos, en especial en aquellas articulaciones en que la superposición de las estructuras óseas impide una clara visualización de las fracturas o luxaciones. Cada articulación mayor cuenta con al menos una clasificación de fractura que trata de recoger los aspectos fundamentales que orientan al tratamiento más efectivo. Ahí es donde la TCMD, con la posibilidad de reconstrucciones multiplanares y tridimensionales, nos aporta una información crucial para el manejo del traumatismo articular (AU)

Multidetector computed tomography (MDCT) has significant advantages over plain-film X-rays in the study of the extremities. Acute trauma poses diagnostic challenges, especially in joints in which the overlapping of bony structures impedes the view of the fractures or luxations. Each major joint has at least one classification system for fractures that aims to include the fundamental aspects necessary to orient the most effective treatment. These are the cases in which MDCT's capabilities for multiplanar and three-dimensional reconstructions provide information that is crucial for the management of trauma to the joint (AU)

Tomografía computarizada y resonancia magnética en las enfermedades dolorosas del raquis: aportaciones respectivas y controversias / Computed tomography and magnetic resonance imaging for painful spinal column: contributions and controversies

Las técnicas de imagen tomográficas, tomografía computarizada (TC) y resonancia magnética (RM) se vienen usando cada vez de forma más frecuente, en sustitución o adición a la radiografía simple, para el estudio del dolor de espalda. El objetivo de este trabajo es realizar una revisión general de las manifestaciones en TC y RM del amplio espectro de enfermedades que pueden ser responsables del dolor generado en la columna vertebral. Este espectro abarca la enfermedad degenerativa, de la alineación vertebral, tumoral, inflamatoria e infecciosa. El conocimiento y la descripción exacta y uniforme de los hallazgos con dichas técnicas suponen un soporte fundamental para la toma de decisiones clínicas en los pacientes con dolor de raquis (AU)

The use of tomographic imaging techniques, computed tomography (CT) and magnetic resonance imaging (MRI), to complement or replace plain-film radiography in the study of spine pain is becoming more and more common. The aim of this paper is to provide a general review of the CT and MRI manifestations of the wide spectrum of lesions that can cause pain in the spinal column. This spectrum includes degenerative disease, malalignment, tumors, inflammatory processes, and infectious processes. Precise knowledge and accurate reporting of the findings at CT and MRI are fundamental for clinical decision making in patients with spine pain (AU)

[Computed tomography and magnetic resonance imaging for painful spinal column: contributions and controversies]. / Tomografía computarizada y resonancia magnética en las enfermedades dolorosas del raquis: aportaciones respectivas y controversias.

The use of tomographic imaging techniques, computed tomography (CT) and magnetic resonance imaging (MRI), to complement or replace plain-film radiography in the study of spine pain is becoming more and more common. The aim of this paper is to provide a general review of the CT and MRI manifestations of the wide spectrum of lesions that can cause pain in the spinal column. This spectrum includes degenerative disease, malalignment, tumors, inflammatory processes, and infectious processes. Precise knowledge and accurate reporting of the findings at CT and MRI are fundamental for clinical decision making in patients with spine pain.

Hepatosplenic brucelloma: clinical presentation and imaging features in six cases.

BACKGROUND: We conducted a retrospective analysis of the clinical presentation and the computed tomographic (CT) and ultrasound (US) findings in six episodes of hepatosplenic brucelloma in five patients. METHODS: In four episodes, the diagnosis was based on clinical history, serology, and characteristic imaging findings. In the other two episodes in the same patient, the diagnosis was suspected after a biopsy was taken. CT was performed in all six cases and US in five. RESULTS: On US, brucellomas were iso- or hypoechogenic with the liver. Hyperechogenic masses were seen in one patient. Brucellomas were very poorly defined and contained small scattered cystic areas. All lesions showed central or marginal gross focal calcification, except multiple lesions in one patient. Contrast-enhanced CT showed predominantly solid masses with irregular borders and fine or thick enhancing trabeculations separating hypodense solid areas and/or small cystic areas. Two patients showed transdiaphragmatic lung invasion by brucelloma, a complication not previously published. CONCLUSION: In regions where brucellosis is endemic, brucelloma should be included in the differential diagnosis if a hepatic or splenic mass with irregular borders and central or marginal gross focal calcification is detected, and contrast-enhanced CT shows enhancing trabeculations that separate hypodense solid areas and/or small liquid collections.