Mario Raguso

Pancoast tumor: the role of magnetic resonance imaging.

We report imaging techniques in the definition of the therapeutic planning of a 65-year-old man with a diagnosis of Pancoast tumor. Computed Tomography has a pivotal role in the assessment of nodes involvement and distant metastasis. Magnetic Resonance allows a detailed study of locoregional extension for its high soft tissue resolution. We particularly highlight the actual importance of Magnetic Resonance Neurography, Diffusion-Weighted Imaging, and Magnetic Resonance Angiography techniques in the assessment of the superior sulcus vascular and nervous structures involvement. Their integrity has been showed in our patient with a complete surgical excision of the lesion.

Management of pain on hallux valgus with percutaneous intra-articular Pulse-Dose Radiofrequency

The purpose of our study was to investigate the role of intra‐articular pulse‐dose radiofrequency in management of painful hallux valgus refractory to conservative therapies.

Pulse-dose radiofrequency can reduce chronic pain in trapezio-metacarpal osteoarthritis: A mini-invasive therapeutic approach

To assess the efficiency of pulse‐dose radiofrequency (PDRF) in the management of chronic pain in patients with trapezio‐metacarpal osteoarthritis (OA).

Degenerative lumbar spinal stenosis treatment with Aperius™ PerCLID™ system and Falena® interspinous spacers: 1-year follow-up of clinical outcome and quality of life

Purpose Evaluation of the efficacy of the Falena® and Aperius™ PerCLID™ interspinous devices in the treatment of degenerative lumbar spinal stenosis with neurogenic intermittent claudication refractory to conservative treatment. Materials and methods We retrospectively analyzed data from 24 patients (20 male and 4 female patients; 61 ± 7 years old), treated with an implantation of the AperiusTM PerCLID™ system, and from 35 patients (29 male and 6 female patients; 65 ± 9 years old) treated with the Falena® interspinous device. Patient pain intensity was evaluated by a 10-point visual analog scale (VAS), with a score (ranging from 0 = no pain to 10 = unbearable pain) that was collected before the procedure, at baseline; and at months 1, 6 and 12 after the interventional procedure. The assessment of quality of life (QOL) impairment was evaluated by the Oswestry Disability Index (ODI) questionnaire, which was administered beforehand at baseline; and at months 1, 6 and 12 after the interventional procedure. The vertebral canal area was measured by magnetic resonance imaging (MRI) scans before the treatment and at the one-year follow-up. Results All patients completed the study with no complications. Both the Falena group and Aperius group of surgery patients showed a statistically significant reduction of their VAS and ODI scores at the 6- and 12-month follow-up (p < 0.0001). A statistically significant increase in the vertebral canal area was observed both in the group that received Falena (p < 0.0001) and in the group that received Aperius (p = 0.0003). At the 1-year follow-up, we observed that there was a higher increase of vertebral canal area in those patients whom were treated with the Falena device (p < 0.001). Conclusions The implantation of Falena® and Aperius™ PerCLID™ interspinous devices is an effective and safe procedure, in the medium term.

Interventional Radiology, Thermoablation and Cryoablation

It is estimated that each year around 5% of all cancer patients develop metastases to the spine. In these patients, pain is the most cardinal symptom. The treatment of bone metastases is determined by a multidisciplinary team where the interventional radiologist is increasingly taking on a crucial role. Open surgery is not frequently used for treatment of bone metastases, owing to its morbidity and the often short life span of the patients. Surgical indications include a fracture with associated a neurologic compromise or high risk of developing pathologic fracture, which could result in neurological damage. Percutaneous cryoablation and thermoablation procedures are the therapeutic choices with a good efficacy in the treatment of painful metastatic lesions refractory to traditional therapies. These ablative methods can also be performed in combination with percutaneous cementoplasty to support and stabilisation for metastases in weight-bearing bones at risk for pathologic fracture.

Pulse-dose radiofrequency treatment in pain management—initial experience

Radiofrequency procedures have been used for treating various chronic pain conditions for decades. These minimally invasive percutaneous treatments employ an alternating electrical current with oscillating radiofrequency wavelengths to eliminate or alter pain signals from the targeted site. The aim of the continuous radiofrequency procedure is to increase the temperature sufficiently to create an irreversible thermal lesion on nerve fibres and thus permanently interrupt pain signals. The pulsed radiofrequency procedure utilises short pulses of radiofrequency current with intervals of longer pauses to avert a temperature increase to the level of permanent tissue damage. The goal of these pulses is to alter the processing of pain signals, but to avoid relevant structural damage to nerve fibres, as seen in the continuous radiofrequency procedure. The pulse-dose radiofrequency procedure is a technical improvement of the pulsed radiofrequency technique in which the delivery mode of the current is adapted. During the pulse-dose radiofrequency procedure thermal damage is avoided. In addition, the amplitude and width of the consecutive pulses are kept the same. The method ensures that each delivered pulse keeps the same characteristics and therefore the dose is similar between patients. The current review outlines the pulse-dose radiofrequency procedure and presents our institution’s chronic pain management studies.

CT/X-ray-Guided Techniques in Vertebral Tumors: Radio-ablation

Primary spinal tumors are relatively rare, estimated around 10% of all cancers interesting spine [1]. The spine is instead the most common site of metastasis in patients with cancer: up to 70% of cancer patients develop secondary spinal disease [2]. New cases of spinal tumors are detected in North America with a rate of incidence near to 18000 patients/year [3].

Discogenic Low Back Pain and Radicular Pain: Therapeutic Strategies and Role of Radio-Frequency Techniques

Low back pain (LBP) is a major problem to public health. Approximately 60 to 80 % of the US population experience back pain at some point of their life [1]. Internal disc disruption (IDD) is an important cause of LBP, accounting for 28 to 43 % of the patients with LBP [2, 3].

Upward Displacement of Prosthetic Aortic Valved Conduit after Modified Bentall Procedure for Type A Acute Aortic Dissection

Aim: Role of non-invasive coronary artery computed tomography (CACT) in diagnosis of complications of aortic root surgery in patients with chest pain. Introduction: Dehiscence of an aortic valved conduit or pseudoaneurysm development is a rare, but serious and potentially life-threatening complication after aortic root surgery. Case Presentation: We report an interesting case of a 61-year-old man with chest pain and dyspnea, previous history of modified Bentall procedure for type A acute aortic dissection and coronary stenting, that shows a complete detachment and upward displacement of a composite tubular graft with mechanical valve prosthesis detected by a CACT angiography. Discussion: Generally, in the few survivors, the diagnosis is made by means of echocardiography. This is the first case of CACT diagnosis of a prosthetic aortic valved conduit displacement after a