Periradicular therapy (PRT)

PRT at a glance

• Goal: Relieve nerve root pain by inhibiting inflammation and reducing swelling of the nerve root
• Typical indications: Herniated disc, foramen stenosis, radicular pain in spinal canal stenosis
• Method: image-guided placement (usually CT or fluoroscopy) of a fine needle to the affected nerve root
• Active ingredients: low-dose cortisone plus local anesthetic
• Procedure: outpatient, short duration; then rest on the same day
• Importance: Part of conservative pain therapy - no guarantee, but often a helpful time window for active rehabilitation
• Alternatives/supplements: Physiotherapy, pain medication, facet/ISG infiltrations, epidural injections, in individual cases surgery

What is periradicular therapy?

During PRT, a small amount of medication is injected precisely into the nerve root area (periradicular) that causes pain. Local inflammation reduction can reduce swelling and irritation of the nerve root. In contrast to more general injections (e.g. epidural), PRT is very targeted - the prerequisite is a careful clinical examination and appropriate imaging.

Who is the PRT suitable for?

PRT is an option if there is radicular pain that radiates into the arm or leg and corresponds to the appropriate nerve root. Basic measures such as exercise therapy, physiotherapy and time-limited pain medication should precede this.

• Herniated disc with nerve root irritation (e.g. sciatica, brachialgia)
• Foraminal stenosis (narrowing of the nerve canal)
• Spinal canal stenosis with radicular pain component
• Postnucleotomy syndrome (persistent radicular complaints after intervertebral disc surgery) – to be examined individually

PRT is not the first choice for non-specific low back pain without radicular signs. In the case of acute neurological deficits (e.g. significant paralysis, bladder-rectal disorders), a prompt neurological/neurosurgical evaluation is indicated instead of PRT.

Contraindications and caution

• Acute infections or fever
• Disorders of blood clotting or anticoagulation (individual consultation required regarding a break)
• Allergies to medications used (local anesthetics, corticosteroids, contrast media)
• Pregnancy (benefit-risk assessment, avoid radiation exposure)
• Poorly controlled diabetes (cortisone can temporarily increase blood sugar)
• Local skin infections at the injection site

A personal risk assessment takes place in the informative discussion. We check whether the benefit-risk ratio is favorable for you and what alternatives exist.

Diagnostics before PRT

Targeted PRT requires the agreement of symptoms, clinical examination and imaging. An MRI of the affected spinal region is often useful to identify the symptomatic nerve root.

• Thorough history and neurological examination
• Examination of radicular signs (dermatomes, reflexes, strength, sensitivity)
• MRI findings correlation (herniated disc, foramen or spinal canal stenosis)
• Consideration of conservative options and timing of PRT

Process: This is how the PRT works

The PRT is usually short and well tolerated. A temporary feeling of warmth or pressure along the radiating pain is not uncommon.

Active principle and active ingredients

The local anesthetic can dampen pain signals in the short term, while the cortisone has a local anti-inflammatory and decongestant effect. This means that mechanical irritation of the nerve root can be better tolerated, making activity and physiotherapy easier.

In individual cases - if there are contraindications to cortisone - a pure local anesthetic injection can be considered, usually with a shorter effective time. Procedures such as ozone or PRP injections on nerve roots are not currently considered standard; We only recommend their use after strict indication testing and evidence-based information.

Efficacy, number of injections and duration

Studies show that PRT, when appropriately selected, can reduce pain in the short to medium term. Individual benefits vary. There are no guarantees.

• Expected effect: from immediate to within a few days
• Duration: often weeks to months; For some patients it is longer, for others it is shorter
• Sessions: often 1-3 injections 1-2 weeks apart; the total dose of cortisone is limited

The main purpose is to create a less painful time window for exercise, everyday life and active therapy - this improves the overall outlook.

Risks and side effects

PRT is considered to be low-risk when indicated correctly and performed image-guided, but it is not completely risk-free.

• Local reactions: temporary pressure/heat pain, hematoma
• Infection: very rare, minimized by sterile technique
• Bleeding/nerve irritation: rare; Risk increases with coagulation disorder
• Allergic reactions to medications or contrast media
• Cortisone-related: temporary increase in blood sugar, facial flushing, sleep disorders
• Rare serious complications (e.g. neurological deficits) – therefore precise image control and experienced hands are important

After the procedure, you will be given clear behavioral instructions and warning signs to look out for.

After PRT: behavior and therapy plan

• Take it easy on the day of treatment and do not actively participate in traffic immediately afterwards
• Cooling possible for local complaints if recommended
• Adjust pain and, if necessary, diabetes medication after medical consultation
• Continue/start early, symptom-adapted exercise and physiotherapy
• If you have a fever, increasing neurological deficits, persistent severe pain or sensory disturbances, please report to a doctor immediately

PRT on the cervical and lumbar spine: special features

In the lumbar spine (lumbar spine), PRT is often performed for sciatica caused by a herniated disc. In the cervical spine (cervical spine) it targets arm pain caused by nerve root irritation. The anatomical conditions are different; Image control (usually CT) increases safety and accuracy. The selection of access routes and dosages depends on the region, findings and individual risk factors.

Alternatives and additions

PRT is not a replacement for active, conservative therapy. The combination is often the most effective.

• Physiotherapy, active training, posture training
• Time-limited pain medication according to guidelines
• Targeted infiltration of other structures (e.g. facet joints, SI joints) if there is a corresponding source of pain
• Epidural injections as an alternative in selected cases
• Surgical procedures in the event of treatment failure or neurological deficits – interdisciplinary clarification

Costs and reimbursement

Coverage of costs can vary depending on insurance, indication and procedure chosen. Private insurance companies usually reimburse according to GOÄ, while statutory health insurance companies reimburse according to individual requirements. We provide transparent information in advance; If in doubt, please clarify the details with your insurance company.

Advice on PRT in Hamburg

Would you like a well-founded assessment of whether PRT might make sense for you? In our orthopedic practice at Dorotheenstrasse 48, 22301 Hamburg, we check the indication, discuss alternatives and - if indicated - plan the image-guided injection in a coordinated, conservative treatment path.