Department of Radiology, Charité, Humboldt-University Medical School, Charitéplatz 1, 10117, Berlin, Germany,
Eur Radiol. 2013 Oct;23(10):2739-46. doi: 10.1007/s00330-013-2872-4. Epub 2013 May 9.
To assess the feasibility, safety and efficacy of real-time MR guidance and thermometry of percutaneous laser disc decompression (PLDD).
Twenty-four discs in 22 patients with chronic low-back and radicular pain were treated by PLDD using open 1.0-T magnetic-resonance imaging (MRI). A fluoroscopic proton-density-weighted turbo spin-echo (PDw TSE) sequence was used to position the laser fibre. Non-spoiled gradient-echo (GRE) sequences were employed for real-time thermal monitoring based on proton resonance frequency (PRF). Radicular pain was assessed over 6 months with a numerical rating scale (NRS).
PLDD was technically successful in all cases, with adequate image quality for laser positioning. The PRF-based real-time temperature monitoring was found to be feasible in practice. After 6 months, 21 % reported complete remission of radicular pain, 63 % at least great pain relief and 74 % at least mild relief. We found a significant decrease in the NRS score between the pre-intervention and the 6-month follow-up assessment (P < 0.001). No major complications occurred; the single adverse event recorded, moderate motor impairment, resolved.
Real-time MR guidance and PRF-based thermometry of PLDD in the lumbar spine under open 1.0-T MRI appears feasible, safe and effective and may pave the way to more precise operating procedures.
• Percutaneous laser disc decompression (PLDD) is increasingly used instead of conventional surgery. • Open 1.0-T MRI with temperature mapping seems technically successful in monitoring PLDD. • Pain relief was at least 'great' in 64 % of patients. • No major complications occurred. • Open 1.0-T MRI appears a safe and effective option for patient-tailored PLDD.
评估实时磁共振引导和经皮激光椎间盘减压术（PLDD）的测温的可行性、安全性和有效性。
对 22 例慢性下腰痛和神经根痛患者的 24 个椎间盘进行了开放式 1.0-T 磁共振成像（MRI）下的 PLDD 治疗。使用透视质子密度加权涡轮自旋回波（PDw TSE）序列定位激光光纤。非扰动脉冲梯度回波（GRE）序列用于基于质子共振频率（PRF）的实时热监测。使用数字评分量表（NRS）在 6 个月内评估神经根痛。
PLDD 在所有病例中均技术成功，激光定位的图像质量足够。基于 PRF 的实时温度监测在实践中是可行的。6 个月后，21%的患者报告完全缓解神经根痛，63%的患者至少有很大程度的缓解，74%的患者至少有轻度缓解。我们发现 NRS 评分在术前和 6 个月随访评估之间有显著下降（P<0.001）。没有发生主要并发症；记录到的唯一不良事件是中度运动障碍，已解决。
在开放式 1.0-T MRI 下，实时磁共振引导和基于 PRF 的 PLDD 腰椎测温似乎是可行的、安全的和有效的，可能为更精确的手术操作铺平道路。
经皮激光椎间盘减压术（PLDD）越来越多地被用于替代传统手术。
开放式 1.0-T MRI 与温度图似乎在监测 PLDD 方面取得了技术成功。
至少有 64%的患者疼痛缓解至少是“很大”。
没有发生主要并发症。
开放式 1.0-T MRI 似乎是一种安全有效的个体化 PLDD 选择。
