Radiological and Radionuclide Imaging of Degenerative Disease of the Facet Joints.

The facet joint has been increasingly implicated as a potential source of lower back pain. Diagnosis can be challenging as there is not a direct correlation between facet joint disease and clinical or radiological features. The purpose of this article is to review the diagnosis, treatment, and current imaging modality options in the context of degenerative facet joint disease. We describe each modality in turn with a pictorial review using current evidence. Newer hybrid imaging techniques such as single photon emission computed tomography/computed tomography (SPECT/CT) provide additional information relative to the historic gold standard magnetic resonance imaging. The diagnostic benefits of SPECT/CT include precise localization and characterization of spinal lesions and improved diagnosis for lower back pain. It may have a role in selecting patients for local therapeutic injections, as well as guiding their location with increased precision.

The short- and medium-term effectiveness of CT-guided selective cervical nerve root injection for pain and disability.

INTRODUCTION: CT-guided cervical nerve root injection with corticosteroid and/or local anesthetic is a recognized technique in the evaluation and treatment of cervical radiculopathy. There are few prospective studies on the efficacy of the various techniques employed in cervical nerve root injection. We present our results from a 1-year prospective series using a CT-guided anterolateral transforaminal approach for cervical nerve root injection of bupivacaine and dexamethasone. METHODS: Pain using a numeric rating scale was assessed at pre-injection, 15 min post-injection, 1 month, and 3 months. Disability was assessed using the Oswestry Neck Disability Index (NDI) questionnaire at pre-injection, 1 month post-injection, and 3 months. RESULTS: In total, 50 patients were followed for 3 months. The mean reductions in pain were: 15 min (77 %), 1 month (39 %), and 3 months (33 %). The mean reductions in NDI were: 1 month (26 %) and 3 months (also 26 %). Results were statistically significant. CONCLUSIONS: CT-guided selective cervical nerve root injection in the treatment of cervical radicular pain and related disability produces statistically significant reductions in pain and disability to at least 3 months post-procedure.

Successful transcatheter arterial embolisation of a cystic artery pseudoaneurysm secondary to calculus cholecystitis: a case report.

Pseudoaneurysms of the cystic artery secondary to calculus cholecystitis are rare. In this report we describe a case of an elderly female who presented with abdominal pain, pyrexia, anaemia and jaundice. She had known chronic cholecystitis, but was not considered a suitable surgical candidate. Contrast enhanced computed tomography (CECT) demonstrated a probable aneurysm within the gallbladder fossa. The patient proceeded to digital subtraction angiography (DSA), which confirmed an aneurysm arising from the cystic artery and was subsequently managed with transcatheter arterial embolisation using coils. This case report reviews the diagnosis and management of this rare complication.