Lateral Decubitus Positioning for Cervical Nerve Root Block Using CT Image Guidance Minimizes Effective Radiation Dose and Procedural Time

Miller, Todd S.; Fruauff, Kristen; Farinhas, Joaquim M.; Pasquale, David; Romano, Camilla; Schoenfeld, Alan H.; Brook, Andrew

doi:10.3174/ajnr.a3158

Cited by 15 publications

(4 citation statements)

References 20 publications

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“…Shepherd et al 17) reported an estimated mean radiation exposure during CT-guided cervical spine injections of 1.1 mSv, with minimum effective dose of only 0.17 mSv. Miller et al 18) reported a mean radiation exposure of 0.51 mSv. Even though radiation exposure under CT guidance is less than that under fluoroscopic guidance, radiation exposure still occurs.…”

Section: Discussionmentioning

confidence: 99%

A Simple, 10-minute Procedure for Transforaminal Injection under Ultrasonic Guidance to Effect Cervical Selective Nerve Root Block

Takeuchi

Kamiya

Wakao

et al. 2014

Neurol. Med. Chir.(Tokyo)

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The aim is to provide a detailed procedure of a simple and 10-minute cervical nerve root block (CNRB) under ultrasonic guidance, and to report the clinical outcomes, disorders, and complications. Records of patients who had undergone CNRB, were reviewed under ultrasonic guidance at the hospital from 2010 through 2012. The procedure is described in detail. Arm and shoulder pain was evaluated by use of the visual analogue scale (VAS). Forty-three patients agreed to undergo CNRB under ultrasonic guidance. Nerve roots from C5 to C8 were affected in 41, and these nerve roots were readily distinguished. Two of the 43 participants did not receive injections because impediments in visualizing the affected nerve root. Of the 41 who received injections, radicular pain immediately disappeared in 39, who continued to feel pain relief 1 month later. However, pain recurred in 15 patients (38%), of whom 11 underwent cervical spine surgery. The rest of 24 patients felt sustained pain relief longer than 3 months after the injection, significantly. Although one patient had recurrent radicular pain 10 months later, the pain could be controlled by medication. At the final follow-up periods, 17.2 (10–24 months), the median VAS score of the patients, 23 (0 to 71 mm), was significantly improvement (P = 0.001) in comparison to before injection 88 (range; 56–100). No complications occurred. The cervical nerve root block under ultrasonic guidance simply, safely, and efficaciously decreased radicular pain for 17.2 months in 62% patients with intolerable radicular pain.

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Section: Discussionmentioning

confidence: 99%

A Simple, 10-minute Procedure for Transforaminal Injection under Ultrasonic Guidance to Effect Cervical Selective Nerve Root Block

Takeuchi

Kamiya

Wakao

et al. 2014

Neurol. Med. Chir.(Tokyo)

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“…As the Dyna-CT incorporates a fully rotatable angiographic unit, with fluoroscopy, using the indicated road map, it also facilitated an excellent needle control and the possibility of immediate needle correction. Miller et al reported that in their study of CT-guided CSNRB the needle needed to be repositioned more than 3 times in about 34% of their punctures [36]. In our trial of 15 punctures only three needed a second attempt.…”

Section: Discussionmentioning

confidence: 48%

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

Freundt

Ritter²,

Al-Zghloul³

et al. 2013

PLoS ONE

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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.

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“…Different DLP to E conversion factors were used from published studies, which depend on the scanned spine region, patient age, acquisition parameters, and time of publication. Not all studies used the same conversion factors, which ranged from 0.005 mSv/(mGy*cm) at the thoracolumbar spine to 0.020 mSv/(mGy*cm) at the cervical spine [41][42][43][44][45][46][47][48][49]. Five studies did not report conversion factors at all.…”

Section: Dose Reporting and Dose Reduction Calculationmentioning

confidence: 99%

Computed Tomography of the Spine

et al. 2022

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The introduction of the first whole-body CT scanner in 1974 marked the beginning of cross-sectional spine imaging. In the last decades, the technological advancement, increasing availability and clinical success of CT led to a rapidly growing number of CT examinations, also of the spine. After initially being primarily used for trauma evaluation, new indications continued to emerge, such as assessment of vertebral fractures or degenerative spine disease, preoperative and postoperative evaluation, or CT-guided interventions at the spine; however, improvements in patient management and clinical outcomes come along with higher radiation exposure, which increases the risk for secondary malignancies. Therefore, technical developments in CT acquisition and reconstruction must always include efforts to reduce the radiation dose. But how exactly can the dose be reduced? What amount of dose reduction can be achieved without compromising the clinical value of spinal CT examinations and what can be expected from the rising stars in CT technology: artificial intelligence and photon counting CT? In this article, we try to answer these questions by systematically reviewing dose reduction techniques with respect to the major clinical indications of spinal CT. Furthermore, we take a concise look on the dose reduction potential of future developments in CT hardware and software.

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Lateral Decubitus Positioning for Cervical Nerve Root Block Using CT Image Guidance Minimizes Effective Radiation Dose and Procedural Time

Cited by 15 publications

References 20 publications

A Simple, 10-minute Procedure for Transforaminal Injection under Ultrasonic Guidance to Effect Cervical Selective Nerve Root Block

A Simple, 10-minute Procedure for Transforaminal Injection under Ultrasonic Guidance to Effect Cervical Selective Nerve Root Block

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

Computed Tomography of the Spine

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