Spinal Injection Techniques

상품상세정보
Written by a multidisciplinary team of experts, Spinal Injection Techniques presents all common methods for the
injection of local anesthetics to address pain from the cervical spine to the sacrum. The authors describe techniques
that are viable alternatives to spine surgery and that do not rely on diagnostic imaging. The first section of the book
covers a general overview of the basic principles, diagnostics, and causal as well as symptomatic pain therapy for the
spine. Designed in atlas format, the second section includes chapters on spinal anatomy and pain signaling, techniques
for injection therapy of the cervical, thoracic and lumbar spine, management of potential complications and side
effects, and multimodal spine therapy. Illustrated by real-life photographs from the author's practice, each technique-
related chapter guides the reader step-by-step and with great precision through the injection procedures.

Highlights:

Provides detailed coverage of injection therapy without the use of image guidance

Features inpatient and outpatient minimally invasive spine therapy, and concomitant pharmaceutical treatments

Includes essential information on contraindications and patient consent

More than 400 color illustrations and photographs demonstrate the relevant anatomy, patient positioning, and accurate
needle placement

Designed as a practical guide and useful compendium, Spinal Injection Techniques is invaluable for orthopedists and
practitioners in physical medicine and rehabilitation. It is also a handy reference for anesthesiologists,
neurologists, and rheumatologists with a specific interest in pain therapy for the spine.




Table of Contents
I GeneralSection
1 █ Basic Principles 3
Orthopedic Pain Therapy . . . . . . . . . . . . . . . . . 3
Nociception and Chronification . . . . . . . . . . . 4
Stages in the Development of Pain . . . . . . . . 5
Moving from Acute to Chronic Pain:
Nociceptor Sensitization . . . . . . . . . . . . . . . . . 6
Secondary Pain . . . . . . . . . . . . . . . . . . . . . . . . . 8
Mixed Pain Syndrome . . . . . . . . . . . . . . . . . . . 9
Chronic Pain Syndrome. . . . . . . . . . . . . . . . . . 10
2 █ Diagnostics 13
Medical History. . . . . . . . . . . . . . . . . . . . . . . . . 13
Clinical Examination. . . . . . . . . . . . . . . . . . . . . 14
Neurological–Orthopedic Examination . . . . . 16
Laboratory Tests . . . . . . . . . . . . . . . . . . . . . . . . 17
Imaging Techniques . . . . . . . . . . . . . . . . . . . . . 18
Trial Measures for the Diagnosis of Pain . . . . 18
3 █ Causal Orthopedic Pain Therapy 19
Positioning and Traction . . . . . . . . . . . . . . . . . 19
Orthopedic Aids . . . . . . . . . . . . . . . . . . . . . . . . 20
Manual Therapy . . . . . . . . . . . . . . . . . . . . . . . . 20
Physical Therapy . . . . . . . . . . . . . . . . . . . . . . . . 21
Postural and Behavioral Training; Back
School. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 22
Back School and Orthopedic Pain Therapy . . 22
4 █ Symptomatic Pain Therapy 25
Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . 25
Thermotherapy . . . . . . . . . . . . . . . . . . . . . . . . . 26
Massage . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 27
Electrotherapy. . . . . . . . . . . . . . . . . . . . . . . . . . 28
Acupuncture . . . . . . . . . . . . . . . . . . . . . . . . . . . 29
Therapeutic Local Injection Treatment . . . . . 30
Interleukin-1 Receptor Antagonist Protein
(IL-1Ra) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 33
Multimodal Medication Concomitant
Therapy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 36
Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . 36
PainMeasurement and Documentation . . . . 36
WHOAnalgesic Ladder . . . . . . . . . . . . . . . . . . 37
OpioidManagement . . . . . . . . . . . . . . . . . . . . 46
Adjuvant Analgesics. . . . . . . . . . . . . . . . . . . . . 46
Local Anesthesia . . . . . . . . . . . . . . . . . . . . . . . . 49
VIII
aus: Theodoridis u.a., Spinal Injection Techniques (ISBN 9783131450715) © 2009 Georg Thieme Verlag KG
II Atlas Section
5 █ The Spine: Anatomy, Nociception, and the Distribution of Pain Signals 53
Terminology . . . . . . . . . . . . . . . . . . . . . . . . . . . 53
Nociception and the Distribution of Pain
Signals in the Spine . . . . . . . . . . . . . . . . . . . . . 53
Pain-Sensitive Structures in the Vertebral
Motor Segment. . . . . . . . . . . . . . . . . . . . . . . . . 53
Spinal Nerve . . . . . . . . . . . . . . . . . . . . . . . . . . . 54
Posterior Longitudinal Ligament . . . . . . . . . . 55
Nerve R oot. . . . . . . . . . . . . . . . . . . . . . . . . . . . . 55
Nociceptive Pain Arising from the
Zygapophyseal Joints . . . . . . . . . . . . . . . . . . . . 57
Muscles . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 57
Mixed Pain Syndromes in the Spine . . . . . . . 59
Chronic Pain Arising from the Vertebrae . . . 59
6 █ Special Orthopedic Injection Therapy: Contraindications and Patient Information 61
Contraindications . . . . . . . . . . . . . . . . . . . . . . . 61 Patient
Information . . . . . . . . . . . . . . . . . . . . . 62
7 █ Cervical Injection Therapy 65
Specialized Cervical Neuroanatomy. . . . . . . . 65
Basic Therapy for Cervical Pain. . . . . . . . . . . . 66
Special Therapy for Cervical Pain . . . . . . . . . . 68
Local Cervical Pain Syndrome. . . . . . . . . . . . . 68
Pain Therapy for the Cervicobrachial
Syndrome . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 70
Treatment of Cervical Headaches
(Cervicocephalic Syndrome). . . . . . . . . . . . . . 71
Pain Therapy for the Posttraumatic Cervical
Syndrome . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 71
Cervical Injection Therapy . . . . . . . . . . . . . . . . 72
Cervical Spinal Nerve Analgesia. . . . . . . . . . . 72
Cervical Epidural Injection . . . . . . . . . . . . . . . 81
Cervical Facet Infiltration (CxFI). . . . . . . . . . . 89
Cervical Trigger Point Infiltration and Skin
Infiltration . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 95
8 █ Thoracic Injection Therapy 99
Specialized Thoracic Neuroanatomy . . . . . . . 99
Clinical Picture . . . . . . . . . . . . . . . . . . . . . . . . . 100
Thoracic Injection Therapy . . . . . . . . . . . . . . . 101
Thoracic Spinal Nerve Analgesia . . . . . . . . . . 101
Thoracic Facet Infiltration (TxFI) . . . . . . . . . . 107
Costotransverse Block (CTB) . . . . . . . . . . . . . . 110
9 █ Lumbar Injection Therapy 113
Specialized Lumbar Neuroanatomy . . . . . . . . 113
Basic Therapy for Lumbar Pain . . . . . . . . . . . . 115
Special Therapy for Lumbar Pain . . . . . . . . . . 118
Local Pain Syndromes in the
Lumbar Spine (Local Lumbar Syndrome,
Nonspecific Back Pain). . . . . . . . . . . . . . . . . . . 118
Treatment of Acute LowBack Pain . . . . . . . . 119
Treatment of Chronic LowBack Pain. . . . . . . 119
Pain Therapy for the Lumbar Nerve Root
Syndrome . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 120
Pain Therapy for Lumbar Spinal Canal
Stenosis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 121
Decompensated Spinal Canal Stenosis . . . . . 121
Pain Therapy for Problem Patients Who
Have Undergone Spinal Surgery . . . . . . . . . . 122
Pain Following Lumbar Spondylodesis . . . . . 124
Lumbar Injection Therapy . . . . . . . . . . . . . . . . 125
Lumbar Spinal Nerve Analgesia . . . . . . . . . . . 125
R adiculography. . . . . . . . . . . . . . . . . . . . . . . . . 139
Lumbar Facet Infiltration. . . . . . . . . . . . . . . . . 139
Ligament Infiltration at the Sacroiliac
Joint (SIJ Block) . . . . . . . . . . . . . . . . . . . . . . . . . 149
Lumbar Epidural Pain Therapy. . . . . . . . . . . . 157
Table of Contents IX
aus: Theodoridis u.a., Spinal Injection Techniques (ISBN 9783131450715) © 2009 Georg Thieme Verlag KG
10 █ General and Specific Complications and Treatment Measures 197
Vasovagal Syncope . . . . . . . . . . . . . . . . . . . . . . 197
Intravascular Administration of Local
Anesthetics and Glucocorticoids . . . . . . . . . . 197
Central Nervous System . . . . . . . . . . . . . . . . . 197
Cardiac Circulatory System. . . . . . . . . . . . . . . 198
Intrathecal Administration of Local
Anesthetics and Glucocorticoids . . . . . . . . . . 199
Anaphylactoid Reaction—Anaphylactic
Shock . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 199
Postdural Puncture Syndrome . . . . . . . . . . . . 201
Bacterial Infection. . . . . . . . . . . . . . . . . . . . . . . 201
Bleeding . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 203
Special Complications and Side Effects of
Cervical Spinal Nerve Analgesia (CSPA). . . . . 204
Stellate Block. . . . . . . . . . . . . . . . . . . . . . . . . . . 204
Pneumothorax . . . . . . . . . . . . . . . . . . . . . . . . . 204
Nerve R oot Sleeve Injection . . . . . . . . . . . . . . 204
Side Effects and Complications of Cervical
Epidural Injections . . . . . . . . . . . . . . . . . . . . . . 206
Dural Puncture . . . . . . . . . . . . . . . . . . . . . . . . . 206
Side Effects and Complications of Thoracic
Injection Techniques. . . . . . . . . . . . . . . . . . . . . 206
Side Effects and Complications of Lumbar
Spinal Nerve Analgesia . . . . . . . . . . . . . . . . . . 206
Spinal Anesthesia . . . . . . . . . . . . . . . . . . . . . . . 206
Kidney Puncture. . . . . . . . . . . . . . . . . . . . . . . . 207
Side Effects and Complications of Lumbar
Epidural Injections . . . . . . . . . . . . . . . . . . . . . . 207
Dural Puncture . . . . . . . . . . . . . . . . . . . . . . . . . 207
11 █ Multimodal Spinal Therapy 209
Outpatient Minimally Invasive Spinal
Therapy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 209
In-patient Minimally Invasive Spinal Therapy 211
Medical Interventions . . . . . . . . . . . . . . . . . . . 212
Physical therapy . . . . . . . . . . . . . . . . . . . . . . . . 212
Psychotherapy. . . . . . . . . . . . . . . . . . . . . . . . . . 212
Special Interventions . . . . . . . . . . . . . . . . . . . . 212
Indications for In-patient Minimally Invasive
Spinal Therapy . . . . . . . . . . . . . . . . . . . . . . . . . 213
Diagnostics Required before Commencing
Minimally Invasive Spinal Therapy . . . . . . . . 213
Multimodal Program . . . . . . . . . . . . . . . . . . . . 214
InitialMedical Intervention . . . . . . . . . . . . . . 214
SecondMedical Intervention . . . . . . . . . . . . . 214
Positioning. . . . . . . . . . . . . . . . . . . . . . . . . . . . . 215
PainMedication . . . . . . . . . . . . . . . . . . . . . . . . 215
Physical therapy . . . . . . . . . . . . . . . . . . . . . . . . 215
Psychotherapy. . . . . . . . . . . . . . . . . . . . . . . . . . 215
The 5–10 Day In-patient Minimally
Invasive Spinal Therapy Program. . . . . . . . . . 215
Osteoporotic Fractures. . . . . . . . . . . . . . . . . . . 216
Further Outpatient Treatment . . . . . . . . . . . . 217
Indications for Surgery . . . . . . . . . . . . . . . . . . 218
Results . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 218
12 █ Summary 221
Cervical Spine . . . . . . . . . . . . . . . . . . . . . . . . . . 221
CSPA (Cervical Spinal Nerve Analgesia) . . . . 221
CEI (Cervical Steroid Injection). . . . . . . . . . . . 222
CxFI (Cervical Facet Infiltration). . . . . . . . . . . 222
Thoracic Spine . . . . . . . . . . . . . . . . . . . . . . . . . . 223
TSPA (Thoracic Spinal Nerve Analgesia) . . . . 223
TxFI (Thoracic Facet Infiltration) . . . . . . . . . . 224
CTB (Costotransverse Block) . . . . . . . . . . . . . . 225
Lumbar Spine/Sacrum . . . . . . . . . . . . . . . . . . . 226
LSPA (Lumbar Spinal Nerve Analgesia) . . . . . 226
LxFI (Lumbar Facet Infiltration) . . . . . . . . . . . 227
SIJ Block (Infiltration of Ligaments at the
Sacroiliac Joint) . . . . . . . . . . . . . . . . . . . . . . . . . 227
Epi-sacral (Sacral Epidural Injection) . . . . . . 228
Epi-posterior (Posterior Epidural Injection) . 229
Epi-peri (Epidural Perineural Injection) . . . . 230
Conclusion . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 231
Bibliography 233
X Table of Contents
aus: Theodoridis u.a., Spinal Injection Techniques (ISBN 9783131450715) © 2009 Georg Thieme Verlag KG