Periradicular Therapy (PRT)

Periradicular therapy (PRT) is a treatment for chronic pain caused by degenerative diseases of the spine, especially in the cervical and lumbar spine. In the PRT, a thin needle is passed close to a nerve root in the spine under computed tomographic monitoring. After having identified the area the medication needs to be injected, the physician places the needle at a specific depth to deliver the medication as close to the problematic nerve(s) as possible.

What is a periradicular therapy (PRT)?

A periradicular therapy (PRT) is a special radiological therapy for chronic back pain caused by wear and tear of the cervical, thoracic, and lumbar spine or a herniated disc or disc bulge. Particially, pain might also radiate to the hips or extremities (radicular symptoms).

Spinal disorders are a common illness. Every 5th visit to the doctor’s office is made because of such complaints. Most commonly, the nerve roots of the lower spine are affected, but also nerve roots of the thoracic and cervical spine can cause problems. Patients are often greatly restricted in their quality of life. The reasons are mostly wear on the small facet joints and the intervertebral discs. This results in the nerves of the spinal canal or at the nerve exit point (neural foramen) to be pressured. The consequence may be an inflammatory reaction caused by the swelling of the nerve. As a result, there is pain in the spine itself, in the buttocks, in the groin area, or in the legs. Additionally, numbness or abnormal sensations, such as the "pins and needles" feeling, as well as heat are symptoms experienced. For the relief of these symptoms, the patient is injected with an anti-inflammatory drug (percutaneous) at the inflamed nerve root (radix). 

A PRT is not suitable for back complaints due to poor posture or muscle injuries of the spine or to changes in individual vertebrae.

How does a periradicular therapy work (PRT)?

Before the implementation of PRT, the affected vertebral body and its nerve roots must be identified reliably. It is therefore necessary to perform an MRI or a CT scan prior to the therapy. The vertebral segment to be treated is adjusted under control by computer tomography (CT) and recorded in an image (measuring settings). This allows determining and controlling the direction and depth of the insertion depth can be controlled. The injection needle is then placed as closely as possible at the nerve root by means of a laser target, and an anti-inflammatory drug (usually a local anesthetic, and cortisone) injected. The therapeutic effect is based on supplying anti-inflammatory medication.  The goal is to break the vicious cycle of the nerve being pressuree and thereby swollen,  by producing even more pressure (decongestant effect).

 

Who and what can be treated (indication)?

PRT is promising in the treatment of the following illnesses:

  • degenerative changes in the facet joints
  • Irritation with bony narrowing of the spinal canal
  • Scar pain after lumbar disc surgery
  • acute low back pain (lumbago), possibly with radiation (sciatica)

 

Equipment technology

The treatment is performed in the computer tomography, where images are taken of the targeted region for localization of the place to be treated, for the control of the needle position, possibly also with administration of a small amount of a contrast substance (see also computed tomography).

 

 

How does the treatment work?

Patients are initially positioned on the abdomen; the place to be treated is thoroughly disinfected. Then (possibly with local anesthesia), a thin needle is gently guided to the spine under image control. The correct position of the needle tip will be checked with a contrast marker, if necessary.  With a good needle position, a mixture of a strongly acting anti-inflammatory drug (usually cortisone), and a local anesthetic is injected. The treatment takes about 5 - 10 minutes.

Improvement usually occurs after a few days. We usually perform three treatments at intervals of one week in order to achieve a longer-lasting improvement of the symptoms.

 

Are there any risks or side effects?

Prior to the treatment, we will have an informed consent discussion with the patient about the treatment process and the existing risks and side effects characteristic for any therapy (bleeding, infection, drug intolerance, nerve injury). Immediately after the treatment, there can be a feeling of numbness or weakness or even a temporary paralysis in the leg. These symptoms usually disappear after 2 to 5 hours (local anesthetic). The day of treatment, patients should avoid stress, sport activities, and heavy lifting. Patients should not operate a motor vehicle immediately after the treatment, but rather arrange for a driver or a taxi.

Who cannot be treated (contraindications)?

Pregnant women

Persons with a severe bleeding disease

Persons with known intolerance to the drugs

Who pays for the treatment?

The periradicular therapy is a standard benefit of all statutory and private health insurance.