1. Failed Back Syndrome Therapy Jalal Jalal Shokouhi –MD Iranian Society of Radiology Secretary Shahid Beheshti & Azad university Ali Akbar Ameri –MD* Hamid Mohammad pour –MD* Hamidreza Edraki –MD* *Shahid Beheshti Med. Univ. Iran Jalaljalalshokouhi@hotmail.com

2. CT GUIDANCE PRT : Periradicular therapy FT : Facet therapy I.S : Intra spinal (intratechal) Sympatectomy : Causalgia * All patients with back school Benefits: Pain reduction Back to work Back to work

3. 2800 patients 1993 to 2007 Failed back syndrome in 1947 Requested by: Neurosurgeons, Orthopedic surgeons, Neurologists, Few other spe. Like internists, cariopractices Male 2496 Female 304

4. Pain control 3,6,12 and 24 months Pain free or low pain 85% Repeat treatment after 1 year therapy 8 patients Repeat treatment more than 4 years 3 patints Spondylolystesis 50% pain free

5. Drugs: 1.Corticosteroid 40-80 Mg. 2.Bupivicain 0.5% 3.Ethanol 65% for FT & Sympatectomy 4.0.5 cc Iodine contrast or air for localization

6. Complications: Minor * Leg Acnea (triamecinolon acetonid, Depomedrol) Major * 3 cases during IS, respiratory distress and collaps due to canal stenosis and local anesthesia migration upward. **one case of staph. septicemia in a hospitallized case ***No mortality

8. Interventional Computed Tomography Rainer M.M. Seibel,M.D., PhD. & Dietrich H.W. Gronemeyer, M.D, PhD. Directors Institute of Diagnostic & Interventional Radiology Medical computer science Private University of Witten/Herdecke MRI – Mulheim Radiologic institute,Germany

13. ADVANTAGES OF CT GUIDANCE PUNCTURE ACCURACY 1mm 3PUNCTURE ACCURACY 1mm 3 NO INJURIES OF NERVE ROOT, AORTA, A.ILIACA OR OTHER NEAR STRUCTURESNO INJURIES OF NERVE ROOT, AORTA, A.ILIACA OR OTHER NEAR STRUCTURES CONTROL OF NUCLEOTOMYCONTROL OF NUCLEOTOMY

14. MICROTHERAPY PERIRADICULAR THERAPY

15. Periradicular Theraphy (PRT)

23. MICROTHERAPY FACETTE DENERVATION

32. INDICATIONS OF PRT FAILED BACK SURGERYFAILED BACK SURGERY HERNIATION OF DISKHERNIATION OF DISK PROTRUSIONPROTRUSION NERVE ROOT COMPRESSION WITH WEAKNESS OR SENSIBLE LOSSNERVE ROOT COMPRESSION WITH WEAKNESS OR SENSIBLE LOSS SPINAL CANAL STENOSISSPINAL CANAL STENOSIS FORAMINAL STENOSISFORAMINAL STENOSIS LATERAL RECESSUS STENOSISLATERAL RECESSUS STENOSIS

38. Thank you for your attention