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Discography is probably the most controversial image-guided procedure performed. It is controversial not because of the technical aspects or periprocedural complications, but rather because of the questionable downstream decision-making relevance and lack of a criterion standard. There is anatomic evidence and hence concept validity that the disc can be a source of pain because of the innervation...
Chronic lower back pain is a common cause of disability, with an estimated 5% of the American population suffering from chronic lumbar area pain. Fortunately, most patients with low back pain respond to conservative therapy. However, epidemiological studies have shown that more than 60% of patients will suffer from recurrent symptoms (1). Of those myriad of patients with low back pain, the prevalence...
The human spine is a study in contrasts. It provides static support for the head and trunk, while providing a kinetic mechanism for flexible movement. Both of these functions are accomplished while providing essential protection for the enclosed spinal cord, spinal roots, and nerves. Accurate diagnosis of spinal disorders depends on a clear understanding of spinal anatomy, and interventional approaches...
Percutaneous vertebroplasty for the treatment of osteoporotic compression fractures was initially introduced in the late 1980s in Europe (1,2) and in the early 1990s in the United States (3). Since that time the procedure has enjoyed a phenomenal growth. Indeed, vertebroplasty is now considered routine in most areas throughout the United States. The procedure has been shown to be rapid, safe, and...
T1- and T2-weighted images are routinely performed in the evaluation of the spine. With T1-weighting, the intervertebral disc demonstrates fairly homogeneous signal intensity that is slightly less than that of the vertebral body red marrow. Epidural fat can be distinguished by its relatively bright appearance or high signal intensity (1). Nerve tissue, on the other hand, is of low intensity (dark...
Prior to the mid-1930s, the vast majority of medical literature concerning low back pain was dedicated to descriptions of the sacroiliac articulation (1,2). More recent studies further show the joint to be a significant contributor to low back pain (3). Diseases or disease states that frequently involve the joint include degenerative, infectious, inflammatory (i.e., ankylo-sing spondylitis, psoriatic...
The facet joints, as true synovial joints, were first postulated as an etiology of low back pain and sciatica more than 90 yr ago (1–3). It was not until 1933, however, that the facet joints themselves were reported to be the source of the back pain, at which time the term “facet syndrome” was coined by Ghormley (4). More recent studies have provided physiologic evidence that the facet joints do indeed...
The specialty of interventional radiology would not exist had it not been for the work of Wilhelm Conrad Roentgen. On November 8, 1895, Roentgen observed a bright fluorescence of barium platinocyanide crystals while experimenting with the Hittorf—Crookes tube. He assumed that the fluorescence might be caused by cathode (β) rays. Using a fluorescent screen he filtered out cathode rays but the phenomenon...
Interventional radiology traditionally involved the treatment of vascular disease, but has grown to include nonvascular intervention and, recently, the treatment of spinal disorders. In Interventional Radiology of the Spine: Image-Guided Pain Therapy, a panel of world-renowned experts presents a complete course on evaluating and treating patients with back pain, including interventional spinal procedures,...
Herein, the authors describe a case of symptomatic, enzymatically positive pancreatitis secondary to inferior vena cava (IVC) penetration by an IVC filter. Computed tomography revealed evidence of a filter strut in the head of the pancreas. Although caval penetration has been shown to be a complication associated with the use of IVC filters, to the authors' knowledge symptomatic pancreatitis is a...
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