Real-time Sonographic Imaging for Periradicular Injections in the Lumbar Spine

Abstract

Objective. We conducted this study to develop a sonographically guided approach to the spinal nerve of the lumbar spine and to assess its feasibility and accuracy by means of computed tomography (CT). Methods. Fifty sonographically guided approaches at 5 levels (L1-S1) were performed on 5 embalmed cadavers, which were positioned prone. The spinal nerves of the lumbar spine were shown under sonographic guidance. In 1 cadaver, the most lateral aspect of the roof of the intervertebral foramen was defined as a reference point. Its position was computed as a distance from the tip of the spinal process (A), the midline (B), and the intervertebral disk (C). Subsequently, axial transverse CT scans were made to verify these distances. In a second part of the experiment, a spinal needle was advanced under sonographic guidance to the spinal nerves for each lumbar spinal level on 1 embalmed cadaver. The exact placement of the needle tips was checked with the help of CT. Results. This technique for a sonographically guided approach to the periradicular area proved to be feasible and accurate. Sonography and CT provided the same mean measurements of 4.0, 2.5, and 1.4 cm for distances A, B, and C, respectively. The Pearson correlation coefficient was 0.99 (P < .001) between sonography and CT. In the experimental study, all 10 needle tips were placed periradicular to the spinal nerves. Conclusions. Sonographic guidance is a useful adjunct to increase the safety and efficacy of periradicular injections in the lumbar spine. Key words: feasibility; periradicular injection; sonography. Neurosurgery (K.G., A.A.O.) and Radiology (G.B., M.F.) and Institute of Anatomy and Histology (H.M.), Leopold-Franzens-University, Innsbruck, Austria; Department of Anesthesiology and Pain Care, Hospital of Vipiteno, Vipiteno, Italy (F.S.K., F.P.); and RTI International, Durham, North Carolina USA (R.S.) Received August 9, 2004, from the Clinics of

A New Simplified Sonographic Approach for Pararadicular Injections in the Lumbar Spine: A CT-Controlled Cadaver Study

“…The currently established technique for sonographyguided lumbar nerve root instillation as proposed by Galiano et al 14 consists of an axial approach toward the respective spinal level. While this technique is optimally suited for lumbar zygapophyseal joint injections because of the ideal visualiza- tion of the joint space in a transverse scanning plane, the authors of this article reported difficulties with nerve root injection in the upper lumbar segments.…”

“…[7][8][9][10] US guidance for spinal injection is a recent development but, according to the literature, seems promising. [11][12][13][14][15][16][17][18][19][20] US has proved sufficiently reliable and accurate in the demonstration of lumbar paravertebral anatomy, [11][12][13][14]21 and the feasibility of US-guided injection therapy at the spine has also been demonstrated in several studies. [11][12][13][14][15][16][17][18][19][20] Although US is considered reliable for different injection procedures of the lumbar spine, [11][12][13][14] some disadvantages of the currently proposed methods-particularly in the upper lumbar spine-have been discussed.…”

Ultrasound-guided versus computed tomography-controlled periradicular injections in the middle and lower cervical spine: a prospective randomized clinical trial

“…In the past, ultrasound (US) has been demonstrated to facilitate the localization and imaging of peripheral nerves, spinal nerve roots and also bony parts of the spine such as facet joints. US-guided approaches tailored for spinal interventions are already available, but only proven for their topographic feasibility [7][8][9][10][11].…”

Ultrasound Guided Spine Injections: Advancement Over Fluoroscopic Guidance?

“…Beginning in 2004, the reports of US guidance in facet procedures in the cervical [31, 47, 50, 65 • , 66-69] and lumbar spine [18,32,70] were described in the literature. Comprehensive review of the literature shows a higher number of quality studies evaluating the role of US in lumbar facetrelated procedures (Table 1).…”

“…Galiano et al [32] described a feasibility and accuracy study of US guidance in the lumbar spine using a transforaminal approach with subsequent CT imaging. Fifty USguided approaches at five levels (L1-S1) were performed on five embalmed cadavers, and the Pearson correlation coefficient was 0.99 (P \ .001) between sonography and CT.…”