Injection therapies play a major role in the treatment of back pain and radiculopathy and are becoming integral parts of a multidisciplinary approach in treatment and rehabilitation of pain patients. Pararadicular and facet-joint injections in the spine are preferentially performed under computed tomography or fluoroscopy guidance. In this article we present alternative, simple, and easy to learn step by step ultrasound-guided techniques for injection therapies in the cervical and lumbar spine.

BACKGROUND AND PURPOSE:Injection therapies play a major role in the treatment of lower back pain and are to date performed mainly under CT or fluoroscopic guidance. The benefits of US-guided instillation procedures have been shown in many studies. We conducted this study to simplify an US-guided approach to the lumbar spinal nerves and to assess the feasibility and preliminary accuracy by means of CT and anatomic dissection.

Purpose We conducted this study to evaluate accuracy, time saving, radiation doses, safety, and pain relief of ultrasound (US)-guided periradicular injections versus computed tomography (CT)-controlled interventions in the cervical spine in a prospective randomized clinical trial. Methods Forty adult patients were consecutively enrolled and randomly assigned to either a US or a CT group. USguided periradicular injections were performed on a standard ultrasound device using a broadband linear array transducer. By basically following the osseous landmarks for level definition in ''in-plane techniques'', a spinal needle was advanced as near as possible to the intended, US-depicted nerve root. The respective needle tip positioning was then verified by CT. The control group underwent CT-guided injections, which were performed under standardized procedures using the CT-positioning laser function. Results The accuracy of US-guided interventions was 100 %. The mean time to final needle placement in the US group was 02:21 ± 01:43 min:s versus 10:33 ± 02:30 min:s in the CT group. The mean dose-length product radiation dose, including CT confirmation for study purposes only, was 25.1 ± 16.8 mGy cm for the US group and 132.5 ± 78.4 mGy cm for the CT group. Both groups showed the same significant visual analog scale decay (p \ 0.05) without ''inter-methodic'' differences of pain relief (p [ 0.05). Conclusions US-guided periradicular injections are accurate, result in a significant reduction of procedure expenditure under the avoidance of radiation and show the same therapeutic effect as CT-guided periradicular injections.

BACKGROUND AND PURPOSE: Injection therapies play a major role in the treatment of lower back pain and are to date performed mainly under CT-or fluoroscopic guidance. We conducted this study to evaluate the accuracy, time savings, radiation doses, and pain relief of US-guided pararadicular injections versus CT-controlled interventions in the lumbar spine in a prospective randomized clinical trial.

The present results show a positive effect of anterior cervical discectomy and fusion on driving safety. Based on our data we state that it appears to be safe to resume driving after discharge from hospital. However, patients scheduled to undergo anterior cervical discectomy and fusion should be informed about increased DRT as compared to healthy individuals.