Christopher J. Centeno, MD
In this free full access article presented by the Journal of Prolotherapy, Dr. Christopher Centeno, M.D., discusses the use of C-arm fluoroscopy, its advantages and disadvantages, when used as guide in Prolotherapy treatments. Below is the abstract from the article.
Interventional pain management traditionally has focused on the use of C-arm fluoroscopy to inject the spine. Fluoroscopy is a real time X-ray designed to allow the physician to guide a needle into a specific location. While Prolotherapy has been performed without the use of imaging guidance, our training in pain management lent itself to using this technology for certain Prolotherapy techniques.
Like many physicians practicing regenerative medicine, our interest in Prolotherapy began because of our general dissatisfaction with the results of injecting steroids. In addition, we were also concerned about the body of literature that demonstrated that injecting high dose steroids (milligram range) could lead to problems in the joint.1-5 This phenomenon, known as apoptosis, means that these medications can shut down all normal repair and maintenance functions in the joint for months, ultimately leading to a less swollen, but more degenerated joint.3 In addition, high dose corticosteroids have also been shown to cause other issues such as systemic side effects and even catastrophic illnesses such as osteonecrosis.6
Osteonecrosis – Loss of blood supply to bone leading to the death of bone tissue.
One solution to this problem is simple, inject much less steroid. In lower concentrations (nanogram range), corticosteroids can have a net positive joint impact (by up regulating TGF-beta production and moving mesenchymal stem cells toward chondrogenic differentiation).7 Despite this modification of the steroid injection, our practice began looking for better options. While Prolotherapy has been considered by some to be controversial, the data supporting the use of hyper-osmolar agents in injection therapy (the medication used in most Prolotherapy solutions) is as good as many of the techniques and procedures used every day in interventional pain management. This led our group to consider combining the use of proliferant injections with our core competency of interventional pain management (driving needles under X-ray).
C-arm fluoroscopy has been used for many years for needle guidance. Its advantage over fixed radiography (usual X-ray techniques performed in a hospital) is 360 degree coverage of any area to be injected and its ability to show live imaging. Its disadvantage is radiation exposure. However, the average radiation exposure during fluoroscopy is on the order of 5-10 cross country plane flights (where the high altitude exposes us to X-ray radiation from the sun).
You can read the entire Journal of Prolotherapy article here: Prolotherapy and fluoroscopy.