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PRT syringe

CT-guided pain management

Targeted pain treatment delivered directly at the site of the pain – under CT guidance and on an outpatient basis. A clinical trial showed that around 74 per cent of patients treated experienced a significant improvement in their symptoms following CT-guided pain therapy

Basics

What is a PRT injection?

For chronic pain originating in the spine, CT-guided pain management is a recognised treatment method. Under CT guidance and monitoring, medication is precisely delivered to the exact site where the pain originates – for example, to a compressed nerve root, degenerative vertebral joints or scar tissue following disc surgery.

CT-guided periradicular therapy enables the injection to be placed very precisely in the area of the affected nerve root. This allows the medication to be delivered directly to the site where the pain may be originating. The imaging helps to ensure the treatment is carried out precisely and in a controlled manner, whilst protecting surrounding structures.

Periradicular therapy typically involves the use of a local anaesthetic and an anti-inflammatory corticosteroid. The medication is administered precisely into the area of the affected nerve root under image guidance, where it acts locally on the source of the pain.

Pain in the lumbar spine is most commonly treated – however, the procedure can also be carried out on the cervical and thoracic spine, as well as on the sacroiliac joints (SI joints).

Also known as: Periradicular therapy | CT-guided infiltration | PRT injection | CT-guided pain therapy | Nerve root block | Injection for a herniated disc

Important: The PRT injection can help to relieve pain and support further treatment planning. In certain cases, it forms part of a conservative treatment plan prior to possible surgical intervention

Indications

When is a PRT injection recommended?

PRT is suitable for a range of spinal conditions in which nerve roots are irritated or compressed.

Herniated disc in the lumbar spine
  • For herniated discs in the lumbar region causing radiating pain down the leg (sciatica).
Herniated disc in the cervical spine
  • In cases of cervical spine disorders with pain radiating into the arm and shoulder (cervicobrachialgia).
Sciatica / Lumbar sciatica
  • Severe pain along the sciatic nerve, which is made worse by movement.
Spinal stenosis
  • Narrowing of the spinal canal, putting pressure on the nerve roots and causing typical difficulties with walking or standing.
Facet syndrome
  • Pain caused by degenerative vertebral joints.
Post-operative pain
  • Persistent nerve pain following spinal surgery (failed-back syndrome).

Mechanism of action & safety

Why is the injection more effective than a tablet?

A key advantage of periradicular therapy lies in its targeted, local application: the medication is administered under image guidance directly into the area of the affected nerve root, where it can act locally. This ensures that the anti-inflammatory and pain-relieving medication is delivered precisely to the area where the symptoms may arise.

Under CT guidance, the injection can be precisely placed in the area of the affected nerve root. This enables the treatment to be carried out in a targeted and controlled manner whilst minimising damage to surrounding structures.

Radiation exposure: optimised low-dose technique

CT-guided pain management utilises modern low-dose protocols to keep radiation exposure as low as possible. For precise needle guidance, only a few control images are usually required, and a full diagnostic CT scan is not necessary.

Radiation exposure is assessed on a case-by-case basis and, where there is a valid medical indication, is proportionate to the expected benefits of the treatment.

In short:

  • Targeted local administration of medication to the affected nerve root
  • Precise placement under CT guidance
  • Controlled treatment with protection of surrounding structures
  • Reduced radiation exposure thanks to modern low-dose techniques
  • Repetition depending on medical indication and individual circumstances

Effectiveness

What is the success rate of the PRT injection?

In a clinical trial, around 74 per cent of the patients treated showed a significant improvement in their symptoms following CT-guided pain management. The key is an accurate diagnosis: if an irritated nerve root or a damaged vertebral joint is identified as the cause of the pain, the chances of success are high.

The treatment can be repeated at short notice if necessary – typically 2 to 3 injections at intervals of a few weeks.

Please note: We cannot guarantee the success of treatment in individual cases. The full effect of the cortisone often only sets in 2–5 days after the injection – please do not assess the result on the first day.

Frequently asked questions about the PRT injection

A correct diagnosis is crucial to the success of treatment: if an irritated or compressed nerve root is confirmed as the cause of the symptoms – for example, due to a herniated disc or spinal stenosis – the prospects of success are high.

Experience shows that purely degenerative changes without active nerve compression respond less well to PRT. Careful pre-treatment diagnosis (MRI or CT) is therefore a prerequisite for treatment.

Important: The full effect of the corticosteroid often only becomes apparent after 2–5 days. Do not assess the success of the treatment on the very first day.

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