PRT

PRT and FT

Radicular pains are of the main reasons that the patients visit neurologists or neurosurgeons. Specialists prescribe different methods such as rest, medicine, or even various types of operations to control the symptoms, but not meant to cure.  Although a combination of various items through CT scan could be applied on the exit points of nerves in the spinal pain or on the Facet joint to control the nerves, they are not meant to cure rather to control the symptoms.

     The painful nerves and their whereabouts would be spotted by the specialists through applying various needles an optimum mixture is injected in the painful zone.

    This method works to 95 % chance of success on relieving the aforesaid pain and could be repeated 4 times in every three weeks’ time interval. In case the pain is not recuperated after fourth time of injection, the probability of the usefulness of the method is too thin.

     Neck ache and backache are the common reasons why patients visit the doctors. Almost 60% of people in general suffer the spinal pain. The outpatients of this major problem have become the second common cause of visiting imaging centers. Surgery is the third one, and generally speaking those outpatients are the other visitors.

    Most of these symptoms would be obviated by maintenance treatment within a week or two; however, a third of them would require full treatment. Differential diagnosis includes the pathology of the body of the disc, disc ruptures, spinal canal stenosis, nerve entrapment, Para spinal muscle involvement, facet joint problems and other spinal causes such as cancer, gastric and duodenal ulcers, pancreatitis, aortic aneurysm and kidney stones.

 The facet joint is a true synovial joint at the juncture of vertebrae. The main causes of the facet syndrome are trauma, arthritis and degeneration. Thoracolumbar zone is the most probable area to be involved in the spines; hence, it occurs due to the sudden change in the direction of the facet joint from the coronal to sagittal.

   The maintenance treatment is recommended for the acute phase or the chronic phase. If the pain isn’t resolved within 6 to 12 weeks, or there are neither neurologic symptoms nor are there egregious radiologic signs, the facet joint syndrome comes into mind.

  In such cases it is recommended to inject a combination of anesthetics and anti-inflammatory drugs under the guidance of CT-scan. There might be contraindications of the injection, patient’s refusal, systemic infection, the skin infection of the injected site, the coagulation disorder (INR) more than 1.2 and the thrombocytopenia (less than 50000).

 The relative contraindications of the patients include not being able to be at prone position, pregnancy, the allergy to the anesthetic drugs and contrast agents as well as psychologic and neurologic disorders. A previous operation surgery on the spinal cord is not considered as one of the contraindications due to the injection, but it would make the injection process harder.

     Such injection is safe and shows some minor disorders such as post injection pain. The most important factor is the aseptic technique. The aforesaid injection could be repeated four times with an interval of three weeks. In case no optimum result is achieved after the fourth injection, this method would not lead to the reduction of the original problem. In PRT the injection zone is the exit points of the nerves which transfer the pain (A and C fibers).  A carries on the sharp pain and C carries on deep and constant pain. The pain on C is probable to be cured by steroid or the ozone therapy.

د.