CT-Targeted Pain Therapy in the Döbling Outpatient Clinic
Prim. Priv.-Doz. Dr. Marius Wick, MSc
Head of the Institute for Imaging Diagnostics and Interventional Radiology at the Döbling Outpatient Clinic
Dr. Wick, in the Outpatient Clinic attached to the Döbling Private Hospital, pain therapy is offered using computer tomography. For which cases is this method suitable?
At our institute, we carry out these procedures on both outpatients and inpatients. At our institute in Döbling, we can offer CT-targeted epidural nerve root blocks in the lumbar spine, the thoracic spine and also in the cervical spine. We also offer CT-targeted reversible denervation of facet joints and sacroiliac joints.
For painful recent vertebral fractures of the thoracic and lumbar spine, I also offer the option of treatment using CT-targeted vertebroplasty. This method is a minimally invasive treatment and stabilization of vertebral fractures by precisely injecting bone cement into the painful vertebral body. The specialists of our network provide the indications for CT-targeted interventions, usually based on clinical examinations and imaging diagnostics using MRI or CT.
For whom is the therapy not recommended and what contraindications are there?
As with all surgical procedures, acute (septic) inflammation, blood-thinning therapy or certain blood diseases as well as allergies to medications such as local anesthetics and cortisone are considered contraindications. Of course, any contraindications will be carefully queried by our medical staff, both in the personal consultation and in detailed patient information sheets before an intervention is carried out.
What are the benefits of this pain therapy?
The advantage of these minimally invasive pain treatments is that they can be carried out without general anesthesia, the appropriate medication can be applied with millimeter precision to where the pain arises and, in most cases, they take a short time. In addition, the costs are much lower compared to “major procedures” in the operating room.
How does CT-targeted pain therapy work and how long does the treatment take?
CT-targeted interventions on the spine are often carried out in the prone position. After making a superficial skin mark and taking a CT image to locate the correct puncture site, the patient's skin is disinfected, covered sterile and superficially iced or anesthetized. The intervention needle is then placed with millimeter precision at the point of pain in the spine using CT. After checking the correct needle position under CT control, the medications are mixed and administered. In the case of outpatient epidural nerve root blocks, patients have to remain lying for a short time after the intervention, the whole procedure lasts about 15 minutes. Then the patient is discharged to home care with an accompanying person. Inpatients come back to their room after the procedure and have to rest in bed for about two hours.
What are the risks of this treatment? How high is the radiation exposure?
As with all interventions involving needles, there is a theoretical risk of bleeding or infection. If patients are on long-term blood-thinning medication, this must be discontinued in good time before the intervention in consultation with the family doctor or internist. In order to exclude the risk of infection, all interventions in our department are carried out in a highly sterile manner and with extreme caution. The radiation exposure is very low because only a few cross-sectional images of the region are taken for planning and during the implementation of the CT-targeted intervention.
What medical qualifications does this treatment require?
These interventions should be carried out by experienced specialists. I personally have the full certificate (level 2 of 2) for interventional radiology from the Austrian Society for Interventional Radiology (“ÖGIR”) and I am specialist trained to carry out all radiological interventions. Due to my years of experience in Austria, as well as chief physician at the Karolinska University Hospital in Stockholm, Sweden, and as a head of department in Döbling, I have all the qualifications necessary for radiologically controlled interventions.
How quickly can you get a treatment appointment for very acute pain and what advantages does the Döbling Outpatient Clinic offer?
There are usually no relevant waiting times for outpatient or inpatient treatment appointments at our institute, and the interventions can be carried out at any time. However, it is important that the indication is determined jointly with the patient, if possible in consultation with one of our partner specialists.
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