Spinal İnjection Techniques PDF
Preview Spinal İnjection Techniques
|13.03.19-20:02 |13.03.19-20:02 |14.03.19-12:26 Spinal Injection Techniques Second Edition Theodoros Theodoridis, MD Head Physician Spine Therapy Department of Minimally Invasive and Surgical Spine Treatment Viktoria Clinic Chairman Institute for Spine Research Bochum, Germany y Juergen Kraemer , MD Formerly Professor Emeritus Orthopedic University Clinic St. Josef Hospital Formerly Chairman Institute for Spine Research Bochum, Germany 503 illustrations Thieme Stuttgart (cid:129) New York (cid:129) Delhi (cid:129) Rio de Janeiro |13.03.19-20:02 LibraryofCongressCataloging-in-PublicationData Importantnote:Medicineisanever-changingscienceundergoing Names:Theodoridis,Theodoros,author.|Kraemer,Juergen, continualdevelopment.Researchandclinicalexperiencearecontin- 1939-2011,author. ually expanding our knowledge, in particular our knowledge of Title:Spinalinjectiontechniques/TheodorosTheodoridis,Juergen propertreatmentanddrugtherapy.Insofarasthisbookmentions Kraemer. anydosageorapplication,readersmayrestassuredthattheauthors, Othertitles:InjektionstherapieanderWirbelsäule.English editors,andpublishershavemadeeveryefforttoensurethatsuch Description:Secondedition.|Stuttgart;NewYork:Thieme, referencesareinaccordancewiththestateofknowledgeatthetime [2019]|Thisbookisanauthorizedandrevisedtranslationofthe ofproductionofthebook. 3rdGermaneditionpublishedandcopyrighted2017byGeorg Nevertheless,thisdoesnotinvolve,imply,orexpressanyguar- ThiemeVerlag,Stuttgart,Germany. anteeorresponsibilityonthepartofthepublishersinrespecttoany TitleoftheGermanedition:InjektionstherapieanderWirbelsäule. dosage instructions andformsofapplicationsstatedinthebook. |Includesbibliographicalreferencesandindex.|Identifiers:LCCN Everyuserisrequestedtoexaminecarefullythemanufacturers’ 2019006657(print)|LCCN 2019007236(ebook)|ISBN leafletsaccompanyingeachdrugandtocheck,ifnecessaryincon- 9783132414488()|ISBN9783132414471(hardcover)| sultationwithaphysicianorspecialist,whetherthedosageschedules ISBN9783132414488(e-book)Subjects:|MESH:–therapy mentionedthereinorthecontraindicationsstatedbythemanufac- |Injections,Spinal–methods|Anesthesia,Spinal|Pain turersdifferfromthestatementsmadeinthepresentbook.Such Management examination is particularly important with drugs that are either Classification:LCCRD771.B217(ebook)|LCCRD771.B217 rarelyusedorhavebeennewlyreleasedonthemarket.Everydosage (print)|NLMWE720 |DDC617.5/6406–dc23 scheduleoreveryformofapplicationusedisentirelyattheuser’s LCrecordavailableathttps://lccn.loc.gov/2019006657 ownriskandresponsibility.Theauthorsandpublishersrequestevery usertoreporttothepublishersanydiscrepanciesorinaccuracies noticed.Iferrorsinthisworkarefoundafterpublication,erratawill bepostedatwww.thieme.comontheproductdescriptionpage. Thisbookisanauthorizedandrevisedtranslationofthe3rdGerman Some of the product names, patents, and registered designs editionpublishedandcopyrighted2017byGeorgThiemeVerlag, referredtointhisbookareinfactregisteredtrademarksorpropri- Stuttgart,Germany.TitleoftheGermanedition:Injektionstherapie etarynameseventhoughspecificreferencetothisfactisnotalways anderWirbelsäule. made in the text. Therefore, the appearance of a name without designationasproprietaryisnottobeconstruedasarepresentation Translatoroforiginalfirstedition:MicheleJames,Nettetal,Germany bythepublisherthatitisinthepublicdomain. Newpartsandupdatestranslatedby:Dr.phil.KarenLeube,Leube TranslationandLanguageServices,Aachen,Germany Photos:RainerJagusch,Digitalimageprocessing ©2019byGeorgThiemeVerlagKG ThiemePublishersStuttgart Rüdigerstrasse14,70469Stuttgart,Germany +49[0]7118931421,[email protected] ThiemePublishersNewYork 333SeventhAvenue,NewYork,NY10001USA +18007823488,[email protected] ThiemePublishersDelhi A-12,SecondFloor,Sector-2,Noida-201301 UttarPradesh,India +911204556600,[email protected] ThiemePublishersRiodeJaneiro ThiemePublicaçõesLtda. EdifícioRodolphodePaoli,25ºandar Av.NiloPeçanha,50–Sala2508 RiodeJaneiro20020-906Brasil +552131722297 Coverdesign:ThiemePublishingGroup TypesettingbyThomsonDigital,India Thisbook,includingallpartsthereof,islegallyprotectedbycopy- PrintedinGermanybyCPIBooks 54321 right.Anyuse,exploitation,orcommercializationoutsidethenarrow limitssetbycopyrightlegislationwithoutthepublisher’sconsentis ISBN978-3-13-241447-1 illegalandliabletoprosecution.Thisappliesinparticulartophotostat reproduction,copying,mimeographingorduplicationofanykind, Alsoavailableasane-book: translating,preparationofmicrofilms,andelectronicdataprocessing eISBN978-3-13-241448-8 andstorage. |13.03.19-20:14 Contents Foreword................................................................................ viii Dr.CordeliaSchott Foreword................................................................................ x ProfessorRüdigerKrauspe Foreword................................................................................ xi ProfessorMichaelRauschmann Preface.................................................................................. xii Contributors............................................................................ xiii PartIGeneralSection 1 BasicPrinciples......................................................................... 2 1.1 OrthopedicPainManagement........ 2 1.3 NociceptionandChronification....... 6 TheodorosTheodoridis,JuergenKraemer TheodorosTheodoridis,JuergenKraemer 1.2 Epidemiology........................ 4 TheodorosTheodoridis,WolframTeske 2 Diagnostics ............................................................................. 15 2.1 MedicalHistory...................... 15 2.4 LaboratoryTests..................... 25 TheodorosTheodoridis,JuergenKraemer TheodorosTheodoridis,Constantinos Georgallas 2.2 ClinicalExamination.................. 16 TheodorosTheodoridis,Constantinos 2.5 ImagingTechniques.................. 25 Georgallas TheodorosTheodoridis 2.3 Neurological–OrthopedicExamination 20 2.6 TrialMeasuresfortheDiagnosisof TheodorosTheodoridis,IliasNastos Pain................................. 27 TheodorosTheodoridis,JuergenKraemer 3 CausalOrthopedicPainTherapy...................................................... 28 TheodorosTheodoridis,JuergenKraemer 3.1 PositioningandTraction.............. 28 3.5 PosturalandBehavioralTraining (BackSchool)........................ 29 3.2 OrthopedicAids ..................... 29 3.6 BackSchoolandOrthopedicPain 3.3 ManualTherapy ..................... 29 Therapy............................. 31 3.4 PhysicalTherapy..................... 29 v |13.03.19-20:14 Contents 4 SymptomaticPainTherapy............................................................ 33 4.1 Introduction......................... 33 4.7 OrthokineTherapy................... 40 TheodorosTheodoridis,JuergenKraemer UlrikeTheodoridis,CordeliaSchott, TheodorosTheodoridis 4.2 Thermotherapy...................... 33 TheodorosTheodoridis,JuergenKraemer 4.8 AdverseEffectsofOrthokine/Cortisone 43 TheodorosTheodoridis 4.3 Massage............................. 34 TheodorosTheodoridis,JuergenKraemer 4.9 ClinicalResults....................... 48 TheodorosTheodoridis 4.4 Electrotherapy....................... 35 TheodorosTheodoridis,JuergenKraemer 4.10 Conclusion .......................... 49 TheodorosTheodoridis 4.5 Acupuncture......................... 36 TheodorosTheodoridis,JuergenKraemer, 4.11 MultimodalMedicationConcomitant ConstantinosGeorgallas Therapy............................. 49 4.6 TherapeuticLocalInjectionTreatment SusanneStehr-Zirngibl (TLIT)................................ 37 TheodorosTheodoridis,JuergenKraemer PartIIAtlasSection 5 TheSpine:Anatomy,Nociception,andtheDistributionofPainSignals.......... 66 TheodorosTheodoridis,JuergenKraemer 5.1 Terminology......................... 66 5.2 NociceptionandtheDistributionof PainSignalsintheSpine.............. 66 6 SpecialOrthopedicInjectionTherapy:ContraindicationsandPatient Information............................................................................. 74 TheodorosTheodoridis 6.2 PatientInformation.................. 74 6.1 Contraindications.................... 74 7 CervicalInjectionTherapy............................................................. 77 7.1 SpecializedCervicalNeuroanatomy ... 77 7.3 SpecialTherapyforCervicalPain...... 80 TheodorosTheodoridis,JuergenKraemer TheodorosTheodoridis,JuergenKraemer 7.2 BasicTherapyforCervicalPain........ 78 7.4 CervicalInjectionTherapy ............ 83 TheodorosTheodoridis,JuergenKraemer 8 ThoracicInjectionTherapy ............................................................ 120 8.1 SpecializedThoracicNeuroanatomy... 120 8.3 ThoracicInjectionTherapy............ 121 TheodorosTheodoridis,JuergenKraemer TheodorosTheodoridis,FritjofBock 8.2 ClinicalPicture....................... 120 TheodorosTheodoridis,JuergenKraemer vi |13.03.19-20:15 Contents 9 LumbarInjectionTherapy............................................................. 146 TheodorosTheodoridis,JuergenKraemer 9.1 SpecializedLumbarNeuroanatomy.... 146 9.4 LumbarInjectionTherapy............. 157 9.2 BasicTherapyforLumbarPain........ 147 9.3 SpecialTherapyforLumbarPain...... 150 10 GeneralandSpecificComplicationsandTreatmentMeasures .................... 255 10.1 VasovagalSyncope................... 255 10.8 SpecialComplicationsandSideEffects ClemensJ.H.Sirtl ofCervicalSpinalNerveAnalgesia (CSPA)............................... 260 10.2 IntravascularAdministrationofLocal TheodorosTheodoridis,WolframTeske, AnestheticsandGlucocorticoids ...... 255 JuergenKraemer ClemensJ.H.Sirtl 10.9 SideEffectsandComplicationsof 10.3 IntrathecalAdministrationofLocal CervicalEpiduralInjections........... 262 AnestheticsandGlucocorticoids ...... 256 LluisAguilariFernàndez,WolframTeske, ClemensJ.H.Sirtl,TheodorosTheodoridis, TheodorosTheodoridis IliasNastos 10.10 SideEffectsandComplicationsof 10.4 AnaphylactoidReaction—Anaphylactic ThoracicInjectionTechniques......... 263 Shock............................... 257 WolframTeske ClemensJ.H.Sirtl 10.11 SideEffectsandComplicationsof 10.5 PostduralPunctureSyndrome ........ 258 LumbarSpinalNerveAnalgesia ....... 263 ClemensJ.H.Sirtl,TheodorosTheodoridis, WolframTeske,JuergenKraemer,Cordelia IliasNastos Schott,TheodorosTheodoridis 10.6 BacterialInfection ................... 259 10.12 SideEffectsandComplicationsof WolframTeske,TheodorosTheodoridis LumbarEpiduralInjections ........... 264 10.7 Bleeding............................. 260 WolframTeske,CordeliaSchott,Theodoros WolframTeske,TheodorosTheodoridis Theodoridis,JuergenKraemer 10.13 Summary............................ 264 11 MultimodalSpinalTherapy ........................................................... 265 TheodorosTheodoridis,JuergenKraemer 11.1 OutpatientMinimallyInvasiveSpinal 11.3 MultimodalProgram................. 269 Therapy............................. 265 TheodorosTheodoridis,JuergenKraemer TheodorosTheodoridis,JuergenKraemer 11.4 MultimodalPainManagement........ 274 11.2 InpatientMinimallyInvasiveSpinal SusanneStehr-Zirngibl,PriskaLaubenthal Therapy............................. 267 TheodorosTheodoridis,JuergenKraemer 12 Summary................................................................................ 275 TheodorosTheodoridis 12.1 CervicalSpine ....................... 275 12.3 LumbarSpine/Sacrum................ 277 12.2 ThoracicSpine....................... 277 12.4 Conclusion .......................... 283 Bibliography............................................................................ 285 Index .................................................................................... 290 vii |13.03.19-20:02 Foreword Foreword Determining appropriate treatment for the cervical, revoking the spinal therapist’s freedom to render thoracic, and lumbar spine pain is a constant chal- treatmentandmakedecisions.Instead,wemustaim lengeforphysicianstoday.Regardlessofthecircum- tooffercurativetreatmentusingtargeted,competent, stancesofourhealthcaresystem,thelackoffunding andearlytherapymanagementwithinterdisciplinary andconcepts,thepolicydebateassociatedwithback treatmentapproachesinorder topreventbackpain pain,thestrugglesbetweenthevariousfactions,and frombecomingchronic. multiple treatment guidelines, conservative treat- Evenifoneassumesthatthebodyofevidenceon mentofspinaldisordersisanintegralcomponentof spinal injection therapy is inadequate, this does not orthopedicsandtraumasurgeryandwillcontinueto changethefactthatspinalinjectiontherapyisoneof play a central role in the foreseeable future. The themostcommonandmostefficienttherapyforms, InterdisciplinarySocietyforOrthopedicandTrauma playing an absolutely key role in daily treatment of Surgery/International Musculoskeletal Pain Society backpainpatients.Anytherapistwhohasusedinjec- (IGOST/IMPS)hasconveyedthismessageinitsinjec- tiontherapytosuccessfullyrelieveapatient’spainina tioncoursesfromdayone.BasedontheworkofIGOST, short periodof timeknowsjusthowimportantand as the representative of the DGOOC pain therapy howefficientthistreatmentoptionis.Inmanycases, section and of DGOU, this book intends to improve thetechniquespresented here are indispensablefor thesafetyandreliabilityofbackpaintherapy. performing differential diagnosis and/or for treat- Policies on “back pain therapy” widely diverge. A ment planning, including surgical options. Often, whole range of professional societies have stakes in using the techniques even allows surgery to be thisarea.Varioustreatmentandotherguidelinesare avoidedaltogether. under development, some of them contradictory, During my timeworkingunder Professor Juergen causingincreasing uncertaintyamong bothpatients Kraemer,Ihadtheprivilegetoobservethetechniques andtreatingphysicians,andintheirwake,legalreg- described in this book on a daily basis, to learn, ulationsandrestrictionsaswellaslimitationsonso- perform,andteachthem,andtofollowupthetreat- called“therapeuticalfreedom,”inotherwords,phy- mentsuccessesformanyyearsandreportaboutthem sicians’ freedom to prescribe what they deem the in scientific publications. For over 15 years, I have most appropriate therapy. There are calls for strict beenpersonallyactiveintheIGOST’shands-oninjec- monitoring along thelines ofevidence-based medi- tion courses. In my daily practice, the injections cine.Atthesametime,thefactthatcommonlyused described here constitute a substantial share of my corticoids are not approved as pharmaceuticals for work. Based on a large part of the life work of my treatingspine-related ailments isalsothesubjectof mentorProfessorJuergen Kraemer, this book repre- politicaldebate.Discussionsareemergingaboutthe sentsthecontinuationofhisideasaboutconservative requiredpresenceorabsenceofimaging,aboutwhich spinaltherapy.Inthissecondedition,theauthorshave payershavetocoverwhichbenefits,andaboutwhois lovinglyupdatedandexpandedonthislegacy. allowed to refer what patient to which treatment Thetherapypresentedinthisbookisconsideredto provider.Inthecontextofthisdebate,painmanage- bethegoldstandardforspinalinjectiontherapyinthe menthasadvancedandthisprogressmustcontinue. framework of orthopedics and trauma surgery and Atthesametime,weneedtocounteractthetendency ideally complements our IGOST courses. The book’s to declare some 90% of all back pain “unspecific” depiction of the anatomical landmarks and the owing to the fact that treatment providers’ training instructionsforlocatingthemmakeitveryusefulfor simplydoesnotpermitmoredetaileddifferentiation. spinaltherapistsperformingconservativetherapyas We also need to prevent excessive use of technical wellasforsurgeons.Thebookthusjoinstheranksof methodsandradiologicalimagingjustforthesakeof notablereferenceworksthathavealsobeenproduced routine or for purely financial reasons, in so doing withtheassistanceofIGOST. viii
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