1. First Announcement-Call for paper………………………… Tehran, 5-7 May 2005 Minimally Interventional Spinal Treatment The First International Congress on the Basic sciences & EpidemiologyBasic sciences & Epidemiology Non-invasive managementNon-invasive management Minimally invasive managementMinimally invasive management Rehabilitation medicineRehabilitation medicine Jalal Jalal Shokouhi-M.D. Interventional Radiology Interventional C.T. Interventional therapy : Microtherapy Facet and peri-Radicular therapy jalaljalalshokouhi@hotmail.com

3. 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

6. Microtherapy Micro endoscopy

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

11. PERCUTANEOUS NUCLEOTOMY IF YOU GOT A NEW HAMMER EVERYTHING LOOKS LIKE A NAIL GARY ONIK

12. ACUTE SCIATIC PAIN  ANTIPHLOGISTICS  COOL  POSITION

13. CHRONIC SCIATIC PAIN  ANTIPHLOGISTICS  WARM  SWIMMING  BACK SCHOOL  MUSCLE TRAINING

14. THERAPY PLAN FOR LUMBAGO CONSERVATIVE THERAPY UP TO 4 WEEKS X ray L spine CT L spine 1.PRT 2.FACETTE BLOCKADE / DENERVATION 3.SURGERY

15. THERAPY PLAN FOR SCIATIA WITHOUTWEAKNESS CONSERVATIVE THERAPY UP TO 2 WEEKS THERAPY PLAN FOR SCIATIA WITHOUT WEAKNESS CONSERVATIVE THERAPY UP TO 2 WEEKS X ray L spine CT L spine NO ACCESS/ RECURRENCE MRI 1.PRT 2.PERCUTANEOUS NUCLEOTOMY 3.SURGERY

16. THERAPY PLAN FOR SCIATIA WITH WEAKNESS IMMEDIATLY X ray L spine, CT L spine and MRI THERAPY IN THE HOSPITAL 1.SURGERY 2.SUBACUTE: PRT

17. MICROTHERAPY PERIRADICULAR THERAPY

18. Periradicular Theraphy (PRT)

28. MICROTHERAPY FACETTE DENERVATION

38. INDICATIONS OF PRT  FAILED BACK SURGERY  HERNIATION OF DISK  PROTRUSION  NERVE ROOT COMPRESSION WITH WEAKNESS OR SENSIBLE LOSS  SPINAL CANAL STENOSIS  FORAMINAL STENOSIS  LATERAL RECESSUS STENOSIS

39. LOCALISATION OF PRT N=370 Lumbar spine 221 59,7% Thoracical spine 16 4,3% Cervical spine 133 36,0%

40. PAINFREE AFTER PRT N=370 Lumbar spine 80% Thoracical spine 82% Cervical spine 74%

41. PERIRADICULAR THERAPY (PRT) Results prospective randomized study FREE OF PAIN AFTER THERAPY VOLON A 40 mg 80% VOLON A 10 mg 55% ( triamcinolonacetonid) N=100

42. SIDEEFFECTS AFTER PRT N=370 Cramp in the calf 8% Weight increase 8% Acne 4% Edema 3% Segmental pain 3% Petechia 0,5% Hormonal disorder ( 5 of 170 ) Hormonal disorder ( 5 of 170 ) 3%

43. RESULTS AFTER PRT N=370 Painfree at the end of therapy 78% Painfree 3 months after therapy 83% Painfree 2 years after therapy ( n=78 ) 68% Second operation at the same level 3,2%

46. Surgery of spine 70-80% Good 20-30% Bad 50-60% Good 40% Poor

47. Microtherapy 8 times “6 months” Every 3 weeks Drugs: PRT= Marcain, Corton, FT= Ethanol, Marcain First, Next injections 2-7 sessions  Facets Ethanol, Marcain  Epidural Marcain, Corton Tria. ~40mg depomedrol Tria.~ 80mg depomedrol

48. Complications Minor: Leg muscle cramp, Acnea 3 cases : collapsed vital signs 1 cases : staphylococus areas Repeated treatments ~7 patients

49. Results from 1992 to 2004 1800 patients 1402 Male 398 Female -pain free 85% in 93% patients Spondylolysthesis 50% pain free -back to work = all patients - All treatments requested by other physicians

51. Thank you for your attention