Fluoroscopy-guided spine injections: establishing a successful service in your radiology department or practice

Deshmukh, Swati; Youngner, Jonathan M.; Garg, Ankur

doi:10.1007/s00256-019-03319-5

Cited by 3 publications

(1 citation statement)

References 12 publications

(17 reference statements)

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“…Fluoroscopic guidance is an imaging guide that is strongly recommended in interventional spine procedures including PRF modulation of DRGs. Radiation exposure is the major health hazard associated with performing fluoroscopic images [8].…”

Section: Introductionmentioning

confidence: 99%

Ultrasound-guided fluoroscopic-verified trans-foraminal lumbar dorsal root ganglion pulsed radiofrequency modulation for radicular pain relief: clinical and cadaveric evaluation of the technique

Omar

Hegab

Reda

et al. 2021

Egypt J Radiol Nucl Med

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Background Ultrasound-guided lumbar pain interventions were thought to be difficult; the high acoustic impedance of bone hides the underling structures and needle path. Reviewing the sonoanatomy of the lumbar region using different planes and angles made better sonographic guidance for spine injections. The aim of this prospective study is to assess the accuracy and safety of ultrasound (US)-guided lumbar trans-foraminal pulsed radiofrequency of the dorsal root ganglion confirmed by fluoroscopic imaging in management of chronic radicular pain. Results Thirty-two patients, with 34 lumbar interventions, were included in the study. Thirty-one interventions out of 34 were performed successfully with overall accuracy of 91.18% and with minimal complications. The successful first trial placement of the cannula was calculated in 44.1% of interventions; multiple trials were needed in 47.1% while incorrect level was encountered in 8.8%. Visual analogue scale of pain and Oswestry Disability Index decreased significantly after intervention up to 3 months compared to the pre-intervention value. The analgesic consumption was reduced by mean of 73.44 ± 31.07% 1 month after intervention. Conclusions US-guided fluoroscopic-verified trans-foraminal PR of lumbar DRG is accurate, safe, and effective for CRP.

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Section: Introductionmentioning

confidence: 99%

Ultrasound-guided fluoroscopic-verified trans-foraminal lumbar dorsal root ganglion pulsed radiofrequency modulation for radicular pain relief: clinical and cadaveric evaluation of the technique

Omar

Hegab

Reda

et al. 2021

Egypt J Radiol Nucl Med

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Safety outcomes and improvement in pain scores after radiologist-performed fluoroscopy-guided interlaminar cervical epidural steroid injection

Guntin,

Regalado,

Serhal

et al. 2023

Skeletal Radiol

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Comparison of operator and patient radiation exposure during fluoroscopy-guided vertebroplasty and kyphoplasty: a systematic review and meta-analysis

Kopparapu¹,

Lubelski²,

Pennington³

et al. 2021

Journal of Neurosurgery: Spine

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OBJECTIVE Percutaneous vertebroplasty (PV) and balloon kyphoplasty (BK) are two minimally invasive techniques used to treat mechanical pain secondary to spinal compression fractures. A concern for both procedures is the radiation exposure incurred by both operators and patients. The authors conducted a systematic review of the available literature to examine differences in interventionalist radiation exposure between PV and BK and differences in patient radiation exposure between PV and BK. METHODS The authors conducted a search of the PubMed, Ovid Medline, Cochrane Reviews, Embase, and Web of Science databases according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Full-text articles in English describing one of the primary endpoints in ≥ 5 unique patients treated with PV or BK of the mobile spine were included. Estimates of mean operative time, radiation exposure, and fluoroscopy duration were reported as weighted averages. Additionally, annual occupational dose limits provided by the United States Nuclear Regulatory Commission (USNRC) were used to determine the number needed to harm (NNH). RESULTS The meta-analysis included 27 articles. For PV, the mean fluoroscopy times were 4.9 ± 3.3 minutes per level without protective measures and 5.2 ± 3.4 minutes with protective measures. The mean operator radiation exposures per level in mrem were 4.6 ± 5.4 at the eye, 7.8 ± 8.7 at the neck, 22.7 ± 62.4 at the torso, and 49.2 ± 62.2 at the hand without protective equipment and 0.3 ± 0.1 at the torso and 95.5 ± 162.5 at the hand with protection. The mean fluoroscopy times per level for BK were 6.1 ± 2.5 minutes without protective measures and 6.0 ± 3.2 minutes with such measures. The mean exposures were 31.3 ± 39.3, 19.7 ± 4.6, 31.8 ± 34.2, and 174.4 ± 117.3 mrem at the eye, neck, torso, and hand, respectively, without protection, and 1, 9.2 ± 26.2, and 187.7 ± 100.4 mrem at the neck, torso, and hand, respectively, with protective equipment. For protected procedures, radiation to the hand was the limiting factor and the NNH estimates were 524 ± 891 and 266 ± 142 for PV and BK, respectively. Patient exposure as measured by flank-mounted dosimeters, entrance skin dose, and dose area product demonstrated lower exposure with PV than BK (p < 0.01). CONCLUSIONS Operator radiation exposure is significantly decreased by the use of protective equipment. Radiation exposure to both the operator and patient is lower for PV than BK. NNH estimates suggest that radiation to the hand limits the number of procedures an operator can safely perform. In particular, radiation to the hand limits PV to 524 and BK to 266 procedures per year before surpassing the threshold set by the USNRC.

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Fluoroscopy-guided spine injections: establishing a successful service in your radiology department or practice

Cited by 3 publications

References 12 publications

Ultrasound-guided fluoroscopic-verified trans-foraminal lumbar dorsal root ganglion pulsed radiofrequency modulation for radicular pain relief: clinical and cadaveric evaluation of the technique

Ultrasound-guided fluoroscopic-verified trans-foraminal lumbar dorsal root ganglion pulsed radiofrequency modulation for radicular pain relief: clinical and cadaveric evaluation of the technique

Safety outcomes and improvement in pain scores after radiologist-performed fluoroscopy-guided interlaminar cervical epidural steroid injection

Comparison of operator and patient radiation exposure during fluoroscopy-guided vertebroplasty and kyphoplasty: a systematic review and meta-analysis

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