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

Abstract

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.

A novel approach to symptomatic lumbar facet joint synovial cyst injection and rupture using iGuide navigational software: A case report and review

“…For example, Freundt et al used iGuide with DynaCT for cervical selective nerve root block in an ex-vivo lamb model and found that compared to CT-guided procedures, they required significantly fewer attempts in accessing the target. 7 Exposure to ionizing radiation remains a concern for fluoroscopy-guided procedures as for CT-guided procedures and this risk must be balanced carefully with the benefits of precise needle guidance. Further study comparing relative radiation exposures for these two approaches is needed.…”

Minimally invasive cone beam CT-guided evacuation of parenchymal and ventricular hemorrhage using the Apollo system: proof of concept in a cadaver model

“…This enables a myriad of imaging-guided interventional procedures within the angiography suite (eg, percutaneous spine interventions, complex peripheral vascular interventions). 17–20 Recently, use of the CB-CT-guided technique has been reported for the placement of external ventricular drains within the angiography suite. 4 …”

Treatment of Supratentorial Spontaneous Intracerebral Hemorrhage Using Image-Guided Minimally Invasive Surgery: Initial Experiences of a Flat Detector CT–Based Puncture Planning and Navigation System in the Angiographic Suite

“…The feasibilities of this puncture planning and guidance system had been previously demonstrated in selective cervical nerve root block, 12 percutaneous kidney puncture, 13 and hepatic tumor ablation 13 based on ex vivo animal models and real patients. Its application in the brain was only recently demonstrated on 6 patients with cerebrovascular ischemia for external ventricular drainage.…”