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Intervention - Details

CT guided injection technique

intervention1 With the CT guided injection technique it is possible to exactly position the needle on the application point of the medication, hereby enabling the treatment of worn out or easily irritated vertebral joints or restricted nerve exit holes (foramina). We usually treat the diseased structures selectively, if necessary, also in succession, so that depending on the realised effect of one or another region can be recognised as the main cause of pain.

  • Periradicular injections on the cervical spine
  • Periradicular injections on the lumbar spine
  • Lumbar vertebrae injection
  • Thermocoagulation

Cervical Periradicular Injection
(Injection at the nerve root under CT guidance)

intervention2

Periradicular Injection Lower Back
(Syringe to the nerve root under CT guidance)

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Facet Joint Lumbar Spine Injection
(Small syringe into the facet joint under CT guidance)

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Thermocoagulation under Computer Tomography

intervention5 There are many causes of back pain. In the case of chronic irritation at worn out vertebral joints, leading to acute pain, it is possible, under a precisely guided CT guidance to treat the affected vertebral joints.

A mixture of local anaesthetic and cortisone (as a very strong anti- inflammatory) is injected at the affected joint: these injections are Performer three times at weekly Intervals. Mostly a lasting improvement of symptoms occurs. In the event that the pain recurs soon after the treatment series, it is possible to achieve a more durable treatment using thermocoagulation. Hereby, the joint networks embracing the vertebral joints will be brought out of function by local heat action.

The thermocoagulation is only considered successful when the injections carried out on the small vertebral joints have, at least temporarily, provided sufficient pain relief. We use this type of stimulation and lesion unit URF-1 with the autoclavable OVL Facet-Rhizotomy kit.

Thermocoagulation

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Image-guided Intra-Articular Injection

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Often it is very possible to determine the best path for a joint injection with palpation of the joint cavity and based on specific anatomical markers.

Sometimes it is difficult due to individual circumstances, so the for the safe localisation of the puncture path, the use of imaging techniques can be advantageous.

Shock wave therapy, ultrasound controlled

intervention8 In shock wave therapy, ultra sound waves enhanced with energy can be used in the high and medium energy shock wave therapy. Through the shock waves, interfering calcium deposits can be destroyed and the other endogenous regularity mechanisms activated, which then lead to healing.

In our practice we use different shock wave generators depending on the disease.

The generator EMS from the company Swiss Dolorklast shock wave pulses compressed by air can be generated in a high frequency and applied to the diseased body part with a hand piece (gun)

Our generator Siemens Sonocur focuses electro hydraulic high-energy shock waves on a water-filled bladder under ultrasound control in pathologically altered tissue.

With this method tendon injuries (tendinopathies) and close-to-bone soft tissue pain can be treated.

These include:

  • Calcification (calcific tendinitis of the supraspinatus tendon)
  • Tennis elbow (lateral epicondylitis)
  • Golfers elbow (epicondylitis humeri ulnaris)
  • Heel spur (plantar calcaneal Tendoperiostose)
  • Patellar syndrome
  • Tibiakanten syndrome
  • Achillodynia
  • Proximal iliotibial tract-rubbing syndrome (outer hip)

Depending on the indications the focus or application of radial shock waves is applied. A more recent field of shock wave treatment is the so-called trigger shock wave therapy, where painful trigger points in the muscle can be treated, and large surface tensions in the muscle can be relaxed.

The shock waves exert their effects at different levels:

The pain is reduced by the release of endogenous pain-inhibitory substances (including endorphins)

Pain transmission is inhibited both by the impairment of cell membranes, so that the pain receiver signals can no longer be built.

However, skin nerve antennae are also stimulated for a variety of sensations and then forward all of the received signals, this also includes pain, through a narrow passageway via the spinal cord to the brain: since very many signals at once pass through this bottleneck, the most painful stimuli is not forwarded but falls to the back.

An increase in metabolism can lead to the activation of self-healing and reduction of calcium deposits.

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