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.

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

Objetivo. Valorar la utilidad de la inyección ecoguiada en la artro-TC y artro-RM de cadera en comparación con la guía radioscópica. Material y métodos. Se revisaron los estudios de artro-RM y artro-TC realizados en el periodo de 1 año entre el 1 de octubre de 2014 y el 1 de octubre de 2015. Se registraron 32 estudios con guía ecográfica y 26 con guía radioscópica, que conformaron dos muestras en las que se valoraron los siguientes parámetros: presencia de una adecuada cantidad de contraste intraarticular, existencia de extravasado o inyección de contraste en partes blandas (presencia de contraste en el psoas o en el resto de partes blandas) y burbujas de gas intraarticular. Posteriormente se realizó un análisis estadístico con el programa SPSS V. 20, en el que se compararon los valores de ambas técnicas mediante la prueba de la ji al cuadrado de Pearson. Resultados. El 56,3% de las inyecciones con ecografía mostraron medio de contraste en las partes blandas, con un 6,3% de procedimientos no válidos para el diagnóstico. Con radioscopia existió extravasado en el 53,8%, con un 3,8% no válido para el diagnóstico. El 21,9% de los estudios con ecografía presentaron gas intraarticular, comparado con el 38,5% en radioscopia. Las diferencias entre los valores de ambas muestras no fueron estadísticamente significativas (p>0,05 en todos los parámetros). Conclusiones. Nuestro estudio demuestra la utilidad de la ecografía como una técnica tan válida como la radioscopia, con la gran ventaja conocida de la ausencia de radiación ionizante (AU)

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 (AU)

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.

Intervencionismo en la columna / Spinal interventions

Presentamos una actualización sobre los diferentes procedimientos intervencionistas percutáneos, guiados mediante técnicas de imagen, y utilizados para el diagnóstico y/o tratamiento de las diversas causas responsables del dolor de raquis. Estos procedimientos pueden ser diagnósticos, terapéuticos o con ambos propósitos. Sus focos de actuación serán fundamentalmente los cuerpos vertebrales, las articulaciones facetarias, el disco intervertebral y las estructuras nerviosas (AU)

We review the state of the art in imaging-guided percutaneous interventional procedures used to diagnose and/or treat the diverse causes of back pain. These procedures can be used for diagnosis, treatment, or both. They are focused on the vertebral bodies, the facet joints, the intervertebral discs, and the nerve structures

Spinal interventions. / Intervencionismo en la columna.

We review the state of the art in imaging-guided percutaneous interventional procedures used to diagnose and/or treat the diverse causes of back pain. These procedures can be used for diagnosis, treatment, or both. They are focused on the vertebral bodies, the facet joints, the intervertebral discs, and the nerve structures.

Osteosarcoma extraesquelético mesentérico primario: hallazgos en imagen / Primary mesenteric extraskeletal osteosarcoma: imaging findings

Presentamos un caso de osteosarcoma extraesquelético originado en la raíz del mesenterio. Esta localización es extremadamente rara; en nuestro conocimiento, se han comunicado en la literatura únicamente otros 3 casos. Describimos los hallazgos en la tomografía computarizada, la tomografía por emisión de positrones y la gammagrafía ósea, haciendo hincapié en el diagnóstico diferencial radiológico en este caso, cuya resolución fue complicada por la concomitancia de otra enfermedad maligna abdominal (AU)

We present a case of extraskeletal osteosarcoma arising from the root of the mesentery. This location is extremely rare; to our knowledge only three other cases have been reported. We describe the findings at computed tomography, positron emission tomography, and bone scintigraphy. We emphasize the radiologic differential diagnosis in this case, which was complicated by the presence of other malignant abdominal disease (AU)

[Primary mesenteric extraskeletal osteosarcoma: imaging findings]. / Osteosarcoma extraesquelético mesentérico primario: hallazgos en imagen.

We present a case of extraskeletal osteosarcoma arising from the root of the mesentery. This location is extremely rare; to our knowledge only three other cases have been reported. We describe the findings at computed tomography, positron emission tomography, and bone scintigraphy. We emphasize the radiologic differential diagnosis in this case, which was complicated by the presence of other malignant abdominal disease.

[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.

La radiografía simple en el estudio del dolor de la columna vertebral / Plain-film radiography in the study of spinal pain

La introducción de las técnicas de imagen tomográficas, fundamentalmente la tomografía computarizada (TC) y resonancia magnética (RM), ha conllevado una paulatina disminución en las indicaciones de la radiología simple, tanto en el número de pacientes como en la cantidad de proyecciones por paciente. Esto ha podido conllevar una menor atención al estudio y conocimiento de la radiografía simple de la columna vertebral en condiciones normales y patológicas.Sin embargo, la radiografía simple aún sigue siendo ampliamente utilizada en atención primaria y especializada. Por tanto, se mantiene vigente el conocimiento de la anatomía radiológica normal y de las manifestaciones radiológicas de los distintos procesos patológicos que afectan a la columna vertebral y que pueden ser responsables del dolor vertebral.El objetivo de este trabajo es realizar una revisión general de las manifestaciones en la radiografía simple del amplio espectro de patologías que pueden ser responsables del dolor generado en la columna vertebral. Este espectro abarca la patología congénita, traumática, degenerativa, tumoral, inflamatoria e infecciosa (AU)

The introduction of tomographic imaging techniques, fundamentally computed tomography and magnetic resonance imaging, has led to a gradual decrease in the indications for plain-film radiography, resulting in fewer patients studied and fewer projections for each patient. Consequently, plain-film studies of the spine have received less attention and radiologists are less familiar with the typical findings in normal and pathologic conditions of the spine.Nevertheless, plain-film radiography continues to be widely used in both primary and specialized care. Thus, radiologists still need to be aware of the normal radiologic anatomy of the spine and of the radiologic manifestations of the diverse pathological processes that can affect the spinal column and that can cause pain.The aim of this article is to review the manifestations on plain-film radiography of a wide variety of diseases that can cause back pain, including congenital, traumatic, degenerative, tumor-related, inflammatory, and infectious diseases and processes (AU)

[Plain-film radiography in the study of spinal pain]. / La radiografía simple en el estudio del dolor de la columna vertebral.

The introduction of tomographic imaging techniques, fundamentally computed tomography and magnetic resonance imaging, has led to a gradual decrease in the indications for plain-film radiography, resulting in fewer patients studied and fewer projections for each patient. Consequently, plain-film studies of the spine have received less attention and radiologists are less familiar with the typical findings in normal and pathologic conditions of the spine. Nevertheless, plain-film radiography continues to be widely used in both primary and specialized care. Thus, radiologists still need to be aware of the normal radiologic anatomy of the spine and of the radiologic manifestations of the diverse pathological processes that can affect the spinal column and that can cause pain. The aim of this article is to review the manifestations on plain-film radiography of a wide variety of diseases that can cause back pain, including congenital, traumatic, degenerative, tumor-related, inflammatory, and infectious diseases and processes.

Osteosarcoma extraóseo / Extraosseous osteosarcoma

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