Ultrasound-guided versus Computed Tomography-controlled facet joint injections in the middle and lower cervical spine: a prospective randomized clinical trial

Galiano, Klaus; Gruber, Hannes; Bale, Reto; Obwegeser, Alois Albert; Schatzer, Reinhold; Loizides, Alexander

doi:10.11152/mu.2013.2066.151.jo1ugc2

Cited by 40 publications

(40 citation statements)

References 30 publications

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“…Sonographic treatment guidance has become established as an alternative method that also does not require radiation exposure or contrast agents. Like MRI compared to CT fluoroscopy, this allows significantly better soft tissue contrast and precise visualization of sensitive structures like the vertebral artery and is primarily suitable for injections in the lower cervical spine segments [41,42]. Exact guidance and localization of the injection cannula increases the safety for the patient.…”

Section: Discussionmentioning

confidence: 99%

MRI-Guided and CT-Guided Cervical Nerve Root Infiltration Therapy: A Cost Comparison

Maurer

Froeling

Röttgen

et al. 2013

Fortschr Röntgenstr

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Purpose: To evaluate and compare the costs of MRI-guided and CT-guided cervical nerve root infiltration for the minimally invasive treatment of radicular neck pain. Materials and Methods: Between September 2009 and April 2012, 22 patients (9 men, 13 women; mean age: 48.2 years) underwent MRI-guided (1.0 Tesla, Panorama HFO, Philips) single-site periradicular cervical nerve root infiltration with 40?mg triamcinolone acetonide. A further 64 patients (34 men, 30 women; mean age: 50.3 years) were treated under CT fluoroscopic guidance (Somatom Definition 64, Siemens). The mean overall costs were calculated as the sum of the prorated costs of equipment use (purchase, depreciation, maintenance, and energy costs), personnel costs and expenditure for disposables that were identified for MRI- and CT-guided procedures. Additionally, the cost of ultrasound guidance was calculated. Results: The mean intervention time was 24.9 min. (range: 12???36?min.) for MRI-guided infiltration and 19.7?min. (range: 5???54?min.) for CT-guided infiltration. The average total costs per patient were EUR 240 for MRI-guided interventions and EUR 124 for CT-guided interventions. These were (MRI/CT guidance) EUR 150/60 for equipment use, EUR 46/40 for personnel, and EUR 44/25 for disposables. The mean overall cost of ultrasound guidance was EUR 76. Conclusion: Cervical nerve root infiltration using MRI guidance is still about twice as expensive as infiltration using CT guidance. However, since it does not involve radiation exposure for patients and personnel, MRI-guided nerve root infiltration may become a promising alternative to the CT-guided procedure, especially since a further price decrease is expected for MRI devices and MR-compatible disposables. In contrast, ultrasound remains the less expensive method for nerve root infiltration guidance. Citation Format: ??Maurer MH, Froeling V, R?ttgen R et?al. MRI-Guided and CT-Guided Cervical Nerve Root Infiltration Therapy: A Cost Comparison. Fortschr R?ntgenstr 2014; 186: 559???566

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Section: Discussionmentioning

confidence: 99%

MRI-Guided and CT-Guided Cervical Nerve Root Infiltration Therapy: A Cost Comparison

Maurer

Froeling

Röttgen

et al. 2013

Fortschr Röntgenstr

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“…Feasibility and 1-year retrospective studies [31,33] all suggest significant utility of US-guidance for cervical nerve root injections. A recent RCT [22] evaluating the feasibility, accuracy and procedural time of USverus CT-guided injections demonstrated that US-guided approaches produced similar results in terms of accuracy and reduction in visual analog scores. In addition, US significantly reduced procedure time.…”

Section: Cervical Epidural Steroid Injectionsmentioning

confidence: 99%

“…It has been well established that US guidance is not only feasible but also clinically useful in the performance of cervical facet joint or medial branch blocks [20][21][22]. Galliano et al published a feasibility study using cadavers to assess US guidance for cervical facet injections.…”

Section: Cervical Facet Jointsmentioning

confidence: 99%

“…In the cervical spine, two randomized controlled trials (RCTs) have been performed that compared US to CT or to FS-guidance for cervical facet blocks. Obernauer et al [22] studied 40 patients and reported superior outcomes with US in terms of accuracy and reduced need for needle REviEW Korbe [21].…”

Section: Cervical Facet Jointsmentioning

confidence: 99%

“…Once the appropriate spinal level is identified, the needle can be guided to the nerve root of interest, using an in-plane approach, and medication is injected [5]. Color Doppler mode has a bigger role in cervical spine injections due to the variable course of the deep cervical artery as well as variable anastomoses between the vertebral and cervical arteries [5,22]. The Doppler mode should also be utilized to identify arteries that may lie in the path of the needle or adjacent to the structure of interest so that vascular puncture is avoided.…”

Section: Cervical Epidural Steroid Injectionsmentioning

confidence: 99%

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Ultrasound-Guided Interventional Procedures for Chronic Pain Management

et al. 2015

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Ultrasonography has multiple advantages over traditional radiologic imaging modalities when used for interventional procedures. It allows improved visualization of the anatomy while avoiding ionizing radiation and risks associated with contrast use. It has proved superiority at accuracy of delivery and procedural effectiveness over blind procedures when used in association with interventional pain procedures. Although limited in its ability to see through bony structures, ultrasound has utility in visualizing soft tissues and vascular structures in anatomic regions of interest resulting in increased use for posterior neuraxial, periaxial, peripheral nerve and joint-related structures. Current evidence for use in these settings is presented here. In some cases, optimal utility may be improved by combining ultrasonography with other imaging modalities. KEYWORDS• chronic pain management Advantages of ultrasound imagingInterventional pain procedures were traditionally performed under fluoroscopic (FS), computed tomography (CT) or MRI guidance. The use of ultrasound (US) to perform injections for chronic pain has significantly increased in the past decade [1,2]. This increase is attributed to its multiple advantages over other imaging modalities including ease of performance, absence of ionizing radiation, better visualization of soft tissue (i.e., muscle, ligament) and blood vessels, real time visualization of needle advancement and, at times, the ability to observe the spread of injectate [3]. US Practice points• Use of ultrasound in medicine has grown with smaller size equipment, increased portability and decreased cost.• Ultrasound has multiple advantages over radiographic imaging when used for interventional pain procedures.• Sonography is useful for medial branch blocks and intra-articular facet blocks in the cervical and lumbar spine but there is little evidence to support its use in the thoracic spine.• Ultrasonography is limited in utility for many types of axial injections because of bony and acoustic shadowing artifact but it does show some promise with transforaminal epidurals or selective nerve root blocks.• Ultrasound guidance is effective in preventing soft tissue and vascular injury in stellate ganglion blocks compared with blind techniques. Soft tissue and vascular anomalies can be identified that fluoroscopic technique will miss.• Ultrasound improves accuracy and efficacy in ilioinguinal, iliohypogastric and genitofemoral blocks for inguinal and testicular pain.• Lateral femoral cutaneous nerve injections are more accurate under ultrasound guidance, especially given the anatomic variation the nerve exhibits in cadaver dissections.• Injections into the knee, shoulder and hip joints are more successful when performed using ultrasound.For reprint orders, please contact: reprints@futuremedicine.com

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Accuracy and efficacy of ultrasound‐guided puncture (vs. computed tomography‐guided) in cervical medial branch blocks for cervicogenic pain: A randomized controlled study

Tian,

Li,

Yin

et al. 2024

Ibrain

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Cervical medial branch block (CMBB) has been recognized as an effective treatment for cervicogenic pain. Previous studies mostly used ultrasound‐guided out‐of‐plane puncture for CMBB, while this prospective study was designed to investigate the efficacy of ultrasound‐guided in‐plane puncture, specifically focusing on the new target of CMBB for cervical pain. This study includes two parts: the accuracy study (N = 15, CMBB was completed by ultrasound and confirmed by computed tomography [CT], in which a good distribution percentage of the analgesic solution was observed) and the efficacy study (N = 40, CMBB was completed by ultrasound or CT, while the proportion of pain relief (numerical rating scale) decrease by more than 50% postoperatively was analyzed). The results showed that the good distribution percentage of the analgesic solution was 97.8%. Furthermore, in the early period (30 min and 2 h postoperatively), the proportion of patients with pain relief was lower in the ultrasound group than that in the CT group, especially at 2 h postoperatively (52% vs. 94%). However, at 24 h postoperatively and later, the proportion of patients with pain relief gradually stabilized to about 60%–70%, and lasted for about 2 weeks to 1 month. Therefore, the new target for CMBB, guided by ultrasound in‐plane, offers high visibility and accuracy. A single CMBB performed under ultrasound guidance resulted in pain relief comparable to that of a CT‐guided procedure (1 day to 1 month postoperatively). This study indicated that CMBB guided by ultrasound in‐plane could be regarded as a promising approach for treatment of cervicogenic pain.

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Ultrasound-guided versus Computed Tomography-controlled facet joint injections in the middle and lower cervical spine: a prospective randomized clinical trial

Abstract: US-guided intra-articular injections show the same therapeutic effect as CT-guided intra-articular injections and result in a significant reduction of procedure duration without any exposure to radiation.

Cited by 40 publications

References 30 publications

MRI-Guided and CT-Guided Cervical Nerve Root Infiltration Therapy: A Cost Comparison

MRI-Guided and CT-Guided Cervical Nerve Root Infiltration Therapy: A Cost Comparison

Ultrasound-Guided Interventional Procedures for Chronic Pain Management

Accuracy and efficacy of ultrasound‐guided puncture (vs. computed tomography‐guided) in cervical medial branch blocks for cervicogenic pain: A randomized controlled study

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