Minimally Invasive Intervention for Spine Pain
MINIMALLY INVASIVE SPINE INTERVENTION
Patient Evaluation and Selection for Minimally Invasive Spine Procedures
A minimally invasive spine procedure may be performed as part of a diagnostic workup or as a primary form of treatment. This form of intervention usually involves a minimal incision and/or the use of needles, probes and/or fiber optic imaging devices. One of the most common reasons for having a minimally invasive approach is for the treatment of pain that is felt to be arising from the spine.
Individuals who suffer from severe or chronic back pain are usually best served by a multidisciplinary team approach. Prior to treating pain it is important to try to identify the primary source of pain. This requires a diagnostic process. The first step in the evaluation process is the history and physical examination. This may be followed by more advanced diagnostic procedures in order to render an accurate diagnosis. After a diagnosis is reached the attending physician(s) can then decide what the best approach is to treat the condition. Determining the primary source of spinal pain can be a daunting challenge even for the most experienced physician. There are a vast number of spinal structures that are pain sensitive including but not limited to bone, muscles, ligaments, nerve structures and various membranes.
The precise placement of needles and probes in and around the spine requires dynamic imaging for guidance. Most image-guided spine procedures are accomplished with fluoroscopy, a specialized application of X-ray imaging. Fluoroscopy uses X-ray to provide imaging from multiple projections. To accomplish this most fluoroscopy units have a C-arm configuration that wraps around an exam table. The head of the X-ray unit is on the C-arm that is motorized and can revolve around the table that the patient is on. This setup allows for dynamic imaging during diagnostic and interventional procedures. Image-guided therapy is typically performed in a specialized room permanently set up with fluoroscopy. Fixed based base C-arm systems are generally preferred over portable systems.
Other forms of imaging technology such as computerized tomography and open magnetic resonance imaging are also used for image-guided therapy. The use of CT has grown due to some of the limitations of fluoroscopy. While CT provides some advantages it is generally less available and more expensive than flouroscopy.
Image Guided Percutaneous Biopsy
Background: Prior to the development of percutaneous biopsy techniques, an open biopsy was required. One of the advantages of open biopsy is that a larger incision is made allowing for greater visualization of the tissue landscape and the ability to extract larger tissue samples. The open biopsy can also be performed during a spinal surgical decompression or stabilization procedure. Current imaging technology can be used to dynamically guide minimally invasive percutaneous biopsy. The percutaneous approach offers several advantages over an open biopsy that includes a faster approach, cost efficient application and overall lower risk of complications. The healing time is also faster. Image-guided spine biopsy can be performed in order to reach small areas surrounded by vital structures with less risk to the surrounding structures and blood vessels.
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