In minimal-invasive back pain therapy, local anaestetic and anti-inflammatory drugs are injected through puncture needles advanced to the painful lesion under fluoroscopy or CT guidance. Main targets are the intervertebral facet joints of the cervical or lumbar spine and the ileo-sacral joints. If this procedure is successful and followed by pain relief, a permanent interruption of neural pain-conductance can be achieved by application of heat (radiofrequency). A similar injection therapy is applied in case of nerve roots irritated by protruded discs or stenoses of the intervertebral foramina. This “periradicular therapy” (PRT) consists out of epidural infiltration of the tissue surrounding the affected nerve. In the case of painful vertebral fractures after trauma, osteoporosis or tumours, the vertebral body can be stabilized by injection of solidifying bone cement through a puncture needle. At the same time, a biopsy is taken for histological examination of the underlying disease. The complication rate of all these minimal-invasive procedures is extremely low in experienced hands.
Prior to the interventions however, other causes of back pain like severe nerve compressions by prolapsed discs, tumours or spinal canal stenoses and metabolic neuropathies must be excluded and a possible psychosomatic background has to be explored. Thus, also in these apparently “small” procedures, an interdisciplinary approach is necessary between neuroradiologists, neurosurgeons, neurologists, orthopeadics and psychologists as it is established in the University Clinic of Mainz.