Feigl G C, Dreu M, Kastner M, Rosmarin W, Ulz H, Kniesel B, Likar R
Institute of Anatomy, Medical University of Graz, Graz, Austria.
Department of Pain Medicine, Pain Clinic "Am Rothenbaum," Hamburg, Germany.
Pain Med. 2017 Jan 1;18(1):36-40. doi: 10.1093/pm/pnw116.
For radiofrequency neurotomy of the medial branch of the lumbar dorsal rami, physicians use techniques guided either by fluoroscopy or computerized tomography (CT), and advocate for their respective techniques. Crucial to the choice of technique is how well each can capture the target nerve. The present study was, therefore, undertaken to assess in cadavers the accuracy of fluoroscopic-guided and CT-guided techniques.
In10 cadavers preserved with Thiel's method, electrodes with 10mm active tips were placed in supine position on the right using a fluoroscopic-guided technique, and on the left using a CT-guided technique. Using a special dissection approach, the relationship between the target nerve and the tip of the electrode was revealed. The displacement between electrode and the nerve, and the extent to which the electrode was parallel to the nerve, were measured with callipers.
Under fluoroscopy guidance, electrodes were placed accurately beside the nerve, and were parallel to it for 9 ±1.9 mm. In only two cases did the electrode pass too deeply. Under CT guidance, electrodes often failed to reach the nerve, but when they did they were parallel to it for only 3.2 ± 3.2 mm. In seven cases, the electrode passed too deeply beyond the target nerve.
The fluoroscopy-guided technique can be relied upon to achieve optimal placement of electrodes on the lumbar medial branches. The CT-guided technique fails to do so, and should not be used in practice until a modified version has been developed and validated.
对于腰椎背根内侧支的射频神经切断术，医生使用荧光透视引导或计算机断层扫描（CT）引导技术，并各自推崇自己所使用的技术。技术选择的关键在于每种技术捕捉目标神经的能力。因此，本研究旨在评估尸体中荧光透视引导技术和CT引导技术的准确性。
在10具采用蒂尔氏方法保存的尸体中，使用荧光透视引导技术在右侧仰卧位放置有源尖端为10毫米的电极，在左侧使用CT引导技术放置电极。采用特殊的解剖方法，揭示目标神经与电极尖端之间的关系。用卡尺测量电极与神经之间的位移以及电极与神经平行的程度。
在荧光透视引导下，电极准确放置在神经旁边，与神经平行的长度为9±1.9毫米。只有两例电极插入过深。在CT引导下，电极常常无法到达神经，但当到达时，与神经平行的长度仅为3.2±3.2毫米。有七例电极插入过深超过了目标神经。
荧光透视引导技术可确保电极在腰内侧支上实现最佳放置。CT引导技术无法做到这一点，在开发并验证改进版本之前，不应在实际中使用。
