Lateral Decubitus Positioning for Cervical Nerve Root Block Using CT Image Guidance Minimizes Effective Radiation Dose and Procedural Time

Miller, Todd S.; Fruauff, Kristen; Farinhas, Joaquim M.; Pasquale, David; Romano, Camilla; Schoenfeld, Alan H.; Brook, Andrew

doi:10.3174/ajnr.a3158

Cited by 15 publications

(5 citation statements)

References 20 publications

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“…Shepherd et al 17) reported an estimated mean radiation exposure during CT-guided cervical spine injections of 1.1 mSv, with minimum effective dose of only 0.17 mSv. Miller et al 18) reported a mean radiation exposure of 0.51 mSv. Even though radiation exposure under CT guidance is less than that under fluoroscopic guidance, radiation exposure still occurs.…”

Section: Discussionmentioning

confidence: 99%

A Simple, 10-minute Procedure for Transforaminal Injection under Ultrasonic Guidance to Effect Cervical Selective Nerve Root Block

Takeuchi

Kamiya

Wakao

et al. 2014

Neurol. Med. Chir.(Tokyo)

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The aim is to provide a detailed procedure of a simple and 10-minute cervical nerve root block (CNRB) under ultrasonic guidance, and to report the clinical outcomes, disorders, and complications. Records of patients who had undergone CNRB, were reviewed under ultrasonic guidance at the hospital from 2010 through 2012. The procedure is described in detail. Arm and shoulder pain was evaluated by use of the visual analogue scale (VAS). Forty-three patients agreed to undergo CNRB under ultrasonic guidance. Nerve roots from C5 to C8 were affected in 41, and these nerve roots were readily distinguished. Two of the 43 participants did not receive injections because impediments in visualizing the affected nerve root. Of the 41 who received injections, radicular pain immediately disappeared in 39, who continued to feel pain relief 1 month later. However, pain recurred in 15 patients (38%), of whom 11 underwent cervical spine surgery. The rest of 24 patients felt sustained pain relief longer than 3 months after the injection, significantly. Although one patient had recurrent radicular pain 10 months later, the pain could be controlled by medication. At the final follow-up periods, 17.2 (10–24 months), the median VAS score of the patients, 23 (0 to 71 mm), was significantly improvement (P = 0.001) in comparison to before injection 88 (range; 56–100). No complications occurred. The cervical nerve root block under ultrasonic guidance simply, safely, and efficaciously decreased radicular pain for 17.2 months in 62% patients with intolerable radicular pain.

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Section: Discussionmentioning

confidence: 99%

A Simple, 10-minute Procedure for Transforaminal Injection under Ultrasonic Guidance to Effect Cervical Selective Nerve Root Block

Takeuchi

Kamiya

Wakao

et al. 2014

Neurol. Med. Chir.(Tokyo)

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“…As the Dyna-CT incorporates a fully rotatable angiographic unit, with fluoroscopy, using the indicated road map, it also facilitated an excellent needle control and the possibility of immediate needle correction. Miller et al reported that in their study of CT-guided CSNRB the needle needed to be repositioned more than 3 times in about 34% of their punctures [36]. In our trial of 15 punctures only three needed a second attempt.…”

Section: Discussionmentioning

confidence: 48%

Laser-Guided Cervical Selective Nerve Root Block with the Dyna-CT: Initial Experience of Three-Dimensional Puncture Planning with an Ex-Vivo Model

Freundt

Ritter²,

Al-Zghloul³

et al. 2013

PLoS ONE

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BackgroundCervical selective nerve root block (CSNRB) is a well-established, minimally invasive procedure to treat radicular cervical pain. However, the procedure is technically challenging and might lead to major complications. The objective of this study was to evaluate the feasibility of a three-dimensional puncture planning and two-dimensional laser-guidance system for CSNRB in an ex-vivo model.MethodsDyna-CT of the cervical spine of an ex-vivo lamb model was performed with the Artis Zee® Ceiling (Siemens Medical Solutions, Erlangen, Germany) to acquire multiplanar reconstruction images. 15 cervical nerve root punctures were planned and conducted with the syngo iGuide® laser-guidance system. Needle tip location and contrast dye distribution were analyzed by two independent investigators. Procedural, planning, and fluoroscopic time, tract length, and dose area product (DAP) were acquired for each puncture.ResultsAll 15 punctures were rated as successful with 12 punctures on the first attempt. Total procedural time was approximately 5 minutes. Mean planning time for the puncture was 2.03 (±0.39) min. Mean puncture time was 2.16 (±0.32) min, while mean fluoroscopy time was 0.17 (±0.06) min. Mean tract length was 2.68 (±0.23) cm. Mean total DAP was 397.45 (±15.63) µGy m2.ConclusionCSNRB performed with Dyna-CT and the tested laser guidance system is feasible. 3D pre-puncture planning is easy and fast and the laser-guiding system ensures very accurate and intuitive puncture control.

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“…The needle is then advanced in the caudal-to-cephalad to the lower lateral aspect of neural foramen after contrast is administered 15) . The procedure time of monoplane fluoroscopy-guided cervical SNRB has been reported to take about 6 min 8) .…”

Section: Monoplane Fluoroscopy Guided Snrbmentioning

confidence: 99%

A New, Effective, Safe, and Accurate Method of Cervical Selective Nerve Root Block

Jeong,

Kim

2023

Nerve

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Objective: Cervical selective nerve root block (SNRB) is an effective procedure that has long been performed for patients with radiating pain or paresthesia. However, there are several delicate structures around the cervical nerve root, damage to which could lead to irreversible neurovascular injury. Therefore, cervical SNRB requires a high skill level and extensive experience to execute it safely. To overcome these disadvantages, we used biplane computed tomography (CT)-guided fluoroscopy and a needle guidance program to achieve symptom improvement in a safer and shorter procedure. This study aimed to investigate the new method and report on its excellent clinical effects.Methods: A total of 57 patients who experienced radiating pain due to cervical spinal stenosis resulting from a herniated disc were enrolled. From September 2020 to September 2021 subjects underwent a biplane CT-guided fluoroscopic nerve block at an outpatient clinic. All procedures were performed by biplane CT-guided fluoroscopy. We analyzed treatment effects with a numerical rating scale (NRS) at 2 and 4 weeks after the procedure. Logistic regression was performed to reveal the significance of changes in NRS after the injection.Results: Pain improved in 56 of 57 patients (98%) after 2 and 4 weeks of follow-up compared to pre-injection pain. At the 2-week follow-up, the mean reduction based on NRS scores was 3.226 (2.782-3.674, 0; 95% confidence interval [CI], p < 0.001) indicating a 48% decrease in pain scores compared with the initial NRS. The mean reduction in NRS 4 weeks after the procedure was 3.544 (3.090-3.998, 0; 95% CI, p < 0.001) indicating a 52% reduction compared with the initial NRS. The average duration of the procedure was 4 minutes. Conclusion: We demonstrate a clinically effective, safe, and accurate method using a biplane CT-guided fluoroscopy and needle guide program. This new method can be an easy and relatively uncomplicated alternative to treatment for patients with cervical radiculopathy and provides safe and accurate targeting, making it easy for inexperienced surgeons.

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Lateral Decubitus Positioning for Cervical Nerve Root Block Using CT Image Guidance Minimizes Effective Radiation Dose and Procedural Time

Cited by 15 publications

References 20 publications

A Simple, 10-minute Procedure for Transforaminal Injection under Ultrasonic Guidance to Effect Cervical Selective Nerve Root Block

A Simple, 10-minute Procedure for Transforaminal Injection under Ultrasonic Guidance to Effect Cervical Selective Nerve Root Block

Laser-Guided Cervical Selective Nerve Root Block with the Dyna-CT: Initial Experience of Three-Dimensional Puncture Planning with an Ex-Vivo Model

A New, Effective, Safe, and Accurate Method of Cervical Selective Nerve Root Block

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