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Needle placement for piriformis injection using 3-D imaging.

Steven R Clendenen¹, Shawn A Candler, Michael D Osborne

¹Department of Anesthesiology, Mayo Clinic, Jacksonville, FL 32224, USA. clendenen.steven@mayo.edu

|May 25, 2013

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This study introduces a novel 3-D computer-assisted technique for piriformis injections, achieving 98% precision. This method enhances accuracy and minimizes radiation exposure for treating piriformis syndrome.

Area of Science:

Medical Imaging
Interventional Pain Management
Neurology

Background:

Piriformis syndrome affects 6-8% of patients with back and leg pain.
Standard treatments utilize fluoroscopy, CT, EMG, and ultrasound (US).
Evolving treatments incorporate CT guidance with EMG and fluoroscopy.

Observation:

A case study details 5 successful piriformis injections using 3-D computer-assisted electromagnetic needle tracking with ultrasound.
A 6-degree of freedom electromagnetic position tracker integrated with the ultrasound probe enabled real-time position and orientation detection.
Image registration between ultrasound and CT/MRI scans was achieved by capturing three points.

Findings:

The navigation system visualized the tracked needle in real-time relative to CT scans using multi-planar reconstructions.

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This novel technique demonstrated 98% precision in needle guidance to the piriformis muscle, avoiding the sciatic nerve.

Ultrasound-guided injections showed triple the accuracy of fluoroscopically guided injections (30%).

Implications:

This technique offers an alternative for piriformis injections with high accuracy and reduced radiation exposure.
Real-time 3-D guidance and electromagnetic instrument tip tracking enhance precision.
While a learning curve exists, this method could become a valuable tool in pain management.