SIR17: Interventional radiology offers minimally invasive relief from sweating, back pain

Patients may soon be getting quality-of-life enhancements with interventional radiology techniques designed to alleviate excessive sweating and pain caused by herniated discs.

A session at the Society of Interventional Radiology 2017 Annual Meeting called “Emerging IR Therapies” examined case studies of new interventional techniques and their clinical viability, including how session attendees could begin using these techniques.

Session co-chair and director of interventional oncology at Johns Hopkins Medicine Christos Georgiades, MD, PhD, illustrated CT-guided chemical sympatholysis, a technique that uses a needle to inject lidocaine and ablates nerves affected by hyperhidrosis.

“It’s amazing. If you inject one side with lidocaine, one hand will stop and be dry immediately,” Georgiades told SIRToday. “It’s not a hormonal problem; this is a neurological problem. The reaction is immediate.”

Georgiades presented impressive results, with almost 60 percent of patients treated having no symptoms of hyperhidrosis during the one-year follow up period. This minimally invasive treatment is a more effective alternative to other first-line treatments such as antiperspirants or medication, but is less taxing than permanent treatments such as bilateral chest surgery to ligate nerves. In addition, the compensatory hyperhidrosis associated with bilateral chest surgery has been observed at a much lower rate for CT-guided sympatholysis.

According to Georgiades, 80 percent of surgical patients experience compensatory hyperhidrosis, while only 15 percent of sympatholysis patients developed excessive sweating in other parts of the body.

Also co-chairing the session was fellow Johns Hopkins radiologist Douglas B. Yim, MD. Yim explained an x-ray-guided alternative to traditional endoscopic lumbar microdisectomy, used to relieve pain from herniated discs. Instead of making a half- to one-inch incision on the lower back, Yim makes a 5-mm incision at the sacral hiatus and uses the holes in the sacrum to access the affected tissue.

The increasing miniaturization of surgical equipment allowed Yim to begin performing the procedure, he said, and the incision can be closed with a single small bandage.

“This is a very natural evolution for the interventional radiologist,” Yim told SIRToday. “It kind of fits in with what we’ve always been doing. It’s just a matter of learning it.”