Ultrasound Guided Versus CT-Controlled Pararadicular Injections in the Lumbar Spine: A Prospective Randomized Clinical Trial

Loizides, Alexander; Gruber, Hannes; Peer, Siegfried; Galiano, Klaus; Bale, Reto; Obernauer, Jochen

doi:10.3174/ajnr.a3206

Cited by 50 publications

(34 citation statements)

References 27 publications

(32 reference statements)

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“…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].…”

Section: Introductionmentioning

confidence: 99%

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

et al. 2013

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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.

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Section: Introductionmentioning

confidence: 99%

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

et al. 2013

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“…The authors assessed and compared accuracy, pain relief and patient comfort. Their results did not show a significant difference in any of the above factors or in degree of pain relief [37]. A second prospective RCT [39] used US to perform lumbar transforaminal ESIs in 80 patients with low back and radicular pain, confirming needle placement with FS.…”

Section: Lumbar Epidural Steroid Injectionsmentioning

confidence: 98%

“…One RCT comparing US-to CT-guidance for lumbar periradicular injections in a group of 40 patients was published in 2013 [37]. The authors assessed and compared accuracy, pain relief and patient comfort.…”

Section: Lumbar 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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“…[35] US has the potential to contribute in detection of important vascular structures at neuroforamen area; however, the performer should be quite experienced for this. Today, fluoroscopy still holds its important place as the preferred imaging method in transforaminal injections.…”

Section: Lumbar Medial Branch Blockadementioning

confidence: 99%

Ultrasound guided chronic pain interventions (Part II)

AKKAYA¹

2016

Agri

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SummaryHenceforth, ultrasonography (US) is an indispensible imaging technique in regional anesthesia practice. With the guidance of US, various invasive interventions in chronic pain pathologies of the musculoskeletal system, peripheral and neuroaxial pathologies has become possible. The management includes diagnostic blocks as weel as radiofrequency ablation and institution of neurolythic agents. During these algologic interventions we are able to see the target tissue, the dispersion of the drug and all nearby vascular structures. Besides these the US also protects the team from ionic radiation that one encounters when using flouroscopy of computed tomography. Latest publication in this field show that applicability of US in chronic pain syndromes is rapidly expanding with a good future. The additional equipment (echogenic needles, 3-D US etc.) will also expands its applications in algology practice. This review highlights different applications of US in chronic pain conditions.

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Ultrasound Guided Versus CT-Controlled Pararadicular Injections in the Lumbar Spine: A Prospective Randomized Clinical Trial

Cited by 50 publications

References 27 publications

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

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

Ultrasound-Guided Interventional Procedures for Chronic Pain Management

Ultrasound guided chronic pain interventions (Part II)

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