Antonio Ursone

Nucleoplasty in the Treatment of Lumbar Diskogenic Back Pain: One Year Follow-Up

PurposeThe spine is an important source of pain and disability, affecting two thirds of adults at some time in their lives. Treatment in these patients is mainly conservative medical management, based on medication, physical therapy, behavioral management, and psychotherapy, surgery being limited to elective cases with neurologic deficits. This study was carried out to evaluate the efficacy of percutaneous nucleoplasty in patients affected by painful diskal protrusions and contained herniations.MethodsFrom February 2004 to October 2005, 72 patients (48 men, 24 women; mean age 48 years) affected by lumbar disk herniation were treated with nucleoplasty coblation. All patients were evaluated clinically and with radiography and MRI in order to confirm the presence of lumbalgic and/or sciatalgic pain, in the absence of major neurologic deficit and with lack of response after 6 weeks of conservative management.ResultsAverage preprocedural pain level for all patients was 8.2 (on a visual analog scale of 1 to 10), while the average pain level at 12 months follow-up was 4.1. At the 1 year evaluation, 79% of patients demonstrated a statistically significant improvement in numeric pain scores (p < 0.01): 17% (12 patients) were completely satisfied with complete resolution of symptoms, and 62% (43 patients) obtained a good result.ConclusionOur data indicate that nucleoplasty coblation is a promising treatment option for patients with symptomatic disk protrusion and herniation who present with lumbalgic and/or sciatalgic pain, have failed conservative therapies, and are not considered candidates for open surgery.

Vertebroplasty and Kyphoplasty in the Treatment of Malignant Vertebral Fractures.

Summary The purpose of this retrospective study was to assess the effectiveness and safety of Percutaneous Vertebroplasty and Kyphoplasty, in the treatment of pain deriving from neoplastic vertebral compression fractures (VCF). We treated 33 oncologic patients with these new techniques (2 pts with aggressive haemangiomas, 8 pts with myelomas and 23 pts with metastases) suffering from severe motion pain in the back, notwithstanding conservative treatment with medication and corset therapy, in the absence of neurological signs. In 3 selected patients we associated radiofrequency heat ablation with vertebroplasty in the treatment of metastases. The aim is to destroy tumor tissue and to thrombose the paravertebral and intravertebral venous plexus before stabilizing the vertebra.

Role of interventional radiology in pudendal neuralgia: a description of techniques and review of the literature

PurposeThe authors sought to evaluate indications, technical feasibility and clinical efficacy of computed tomography (CT)-guided pudendal nerve infiltration in patients with chronic anoperineal pain by reviewing the role of the CT technique in their personal experience and in the recent interventional literature.Materials and methodsTwenty-eight women, mean age 50 years, and with a diagnosis of pudendal neuralgia on the basis of clinical and electromyographic criteria were enrolled in the study. CT-guided pudendal nerve injections were performed during three consecutive sessions held 2 weeks apart. In each session, patients received two percutaneous injections: one in the ischial spine, and the other in the pudendal (Alcock’s) canal.ResultsOne patient dropped out of the study after the first session. At clinical assessment, 24h h after treatment, 21/27 patients reported significant pain relief. At follow-up at 3, 6, 9 and 12 months, 24/27 patients reported a≥20% improvement in the Quality of Life (QOL) index. Conclusions. In pudendal nerve entrapment, CT-guided perineural injection in the anatomical sites of nerve impingement is a safe and reproducible treatment with a clinical efficacy of 92% at 12 months.RiassuntoObiettivoValutare le indicazioni, la fattibilità tecnica e l’efficacia clinica della infiltrazione TC guidata del nervo pudendo in pazienti con sindrome ano-perineale nevralgica effettuando una revisione del ruolo della tecnica TC nella letteratura recente in ambito interventistico.Materiali e metodiVentotto donne con età media 50 anni e diagnosi di nevralgia del pudendo effettuata sulla base di criteri clinici ed elettromiografici, sono state incluse nel nostro studio. Le iniezioni del nervo pudendo sono state eseguite sotto guida TC, in 3 sedute intervallate da 2 settimane. In ogni seduta, sono state effettuate due sessioni di trattamento iniettivo percutaneo, la prima iniezione è stata effettuata a livello della spina ischiatica e la seconda a livello del canale di Alcock.RisultatiIn un caso la procedura è stata interrotta dopo la prima sessione, è pertanto tale paziente e stata esclusa dalla successiva valutazione. Nella valutazione a ventiquattrore post-trattamento è stato riferito un miglioramento qualitativo significativo della sintomatologia dolorosa in 21 casi su 27; in 24 su 27 casi è stato riportato un miglioramento ≥20% dell’indice di qualità della vita (QOL index) nel follow-up clinico a 3, 6, 9 e 12 mesi.ConclusioniNella sindrome da intrappolamento del nervo pudendo, l’iniezione perineurale TC guidata delle sedi anatomiche di conflitto nervoso risulta una procedura sicura e ripetibile con una efficacia clinica nel 92% dei pazienti trattati nel follow-up a 12 mesi.