Ultrasound-guided cervical selective nerve root injections: a narrative review of literature

Ehsanian, Reza; Schneider, Byron J.; Kennedy, David J.; Koshkin, Eugene

doi:10.1136/rapm-2020-102325

Cited by 8 publications

(7 citation statements)

References 76 publications

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“…Since the solution to gel transition of our formulation occurs within a physiologically relevant temperature window, we sought to prove that we could successfully noninvasively inject it under ultrasound guidance, a common imaging modality. In humans, ultrasound-guided injections have been explored extensively and injections of agents including steroids are routinely performed. − Even in the small mouse hindlimb, we were able to visualize the sciatic nerve and successfully inject 4-AP thermogel onto the injury site. It remains to be seen whether ultrasound-guided injection of our agent in humans is feasible.…”

Section: Discussionmentioning

confidence: 99%

(4-Aminopyridine)–PLGA–PEG as a Novel Thermosensitive and Locally Injectable Treatment for Acute Peripheral Nerve Injury

Manto

Govindappa

Parisi

et al. 2021

ACS Appl. Bio Mater.

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Traumatic peripheral nerve injury (TPNI) represents a major medical problem that results in loss of motor and sensory function, and in severe cases, limb paralysis and amputation. To date, there are no effective treatments beyond surgery in selective cases. In repurposing studies, we found that daily systemic administration of the FDA-approved drug 4aminopyridine (4-AP) enhanced functional recovery after acute peripheral nerve injury. This study was aimed at constructing a novel local delivery system of 4-AP using thermogelling polymers. We optimized a thermosensitive (4-AP)−poly(lactide-co-glycolide)−b-poly(ethylene glycol)−b-poly(lactide-co-glycolide) (PLGA−PEG−PLGA) block copolymer formulation. (4-AP)− PLGA−PEG exhibited controlled release of 4-AP both in vitro and in vivo for approximately 3 weeks, with clinically relevant safe serum levels in animals. Rheological investigation showed that (4-AP)−PLGA−PEG underwent a solution to gel transition at 32 °C, a physiologically relevant temperature, allowing us to administer it to an injured limb while subsequently forming an in situ gel. A single local administration of (4-AP)−PLGA−PEG remarkably enhanced motor and sensory functional recovery on post-sciatic nerve crush injury days 1, 3, 7, 14, and 21. Moreover, immunohistochemical studies of injured nerves treated with (4-AP)-PLGA-PEG demonstrated an increased expression of neurofilament heavy chain (NF-H) and myelin protein zero (MPZ) proteins, two major markers of nerve regeneration. These findings demonstrate that (4-AP)−PLGA−PEG may be a promising long-acting local therapeutic agent in TPNI, for which no pharmacologic treatment exists.

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Section: Discussionmentioning

confidence: 99%

(4-Aminopyridine)–PLGA–PEG as a Novel Thermosensitive and Locally Injectable Treatment for Acute Peripheral Nerve Injury

Manto

Govindappa

Parisi

et al. 2021

ACS Appl. Bio Mater.

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“…Recently, an ultrasound‐guided approach for transforaminal CESI has been proposed 83 . The available evidence suggests non‐inferiority to fluoroscopy‐guided techniques, but there is still a paucity of adequately powered clinical studies evaluating the accuracy and effectiveness of using ultrasound guidance 84 . This technique has important limitations in terms of visualization of anatomy, with the evidence available at this time suggesting it is best used in combination with fluoroscopy.…”

Section: Treatmentsmentioning

confidence: 99%

2. Cervical radicular pain

et al. 2023

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IntroductionCervical radicular pain is pain perceived in the upper limb, caused by irritation or compression of a cervical spine nerve, the roots of the nerve, or both.MethodsThe literature on the diagnosis and treatment of cervical radicular pain was retrieved and summarized.ResultsThe diagnosis is made by combining elements from the patient's history, physical examination, and supplementary tests. The Spurling and shoulder abduction tests are the two most common examinations used to identify cervical radicular pain. MRI without contrast, CT scanning, and in some cases plain radiography can all be appropriate imaging techniques for nontraumatic cervical radiculopathy. MRI is recommended prior to interventional treatments. Exercise with or without other treatments can be beneficial. There is scant evidence for the use of paracetamol, nonsteroidal anti‐inflammatory drugs, and neuropathic pain medications such as gabapentin, pregabalin, tricyclic antidepressants, and anticonvulsants for the treatment of radicular pain. Acute and subacute cervical radicular pain may respond well to epidural corticosteroid administration, preferentially using an interlaminar approach. By contrast, for chronic cervical radicular pain, the efficacy of epidural corticosteroid administration is limited. In these patients, pulsed radiofrequency treatment adjacent to the dorsal root ganglion may be considered.ConclusionsThere is currently no gold standard for the diagnosis of cervical radicular pain. There is scant evidence for the use of medication. Epidural corticosteroid injection and pulsed radiofrequency adjacent to the dorsal root ganglion may be considered. [Correction added on 12 June 2023, after first online publication: The preceding sentence was corrected.]

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“…Two studies comparing the rate of vascular uptake in fluoroscopic vs. ultrasound-guided cervical transforaminal epidural steroid injections found no difference between the two techniques [ 49 , 50 ]. A narrative review by Ehsanian et al therefore suggests a combination of initial ultrasound guidance with fluoroscopic confirmation to minimize the adverse effects and shortcomings of either singular technique [ 51 ]. The optimal technique has yet to be elucidated, and currently requires additional adequately powered superiority studies.…”

Section: Differentiating Lumbar Radiculopathymentioning

confidence: 99%

The Role of Diagnostic Injections in Spinal Disorders: A Narrative Review

et al. 2021

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Neck and back pain is increasingly prevalent, and has increased exponentially in recent years. As more resources are dedicated to the diagnosis of pain conditions, it is increasingly important that the diagnostic techniques used are as precise and accurate as possible. Traditional diagnostic methods rely heavily upon patient history and physical examination to determine the most appropriate treatments and/or imaging studies. Though traditional means of diagnosis remain a necessity, in many cases, correlation with positive or negative responses to injections may further enhance diagnostic specificity, and improve outcomes by preventing unnecessary treatments or surgeries. This narrative review aims to present the most recent literature describing the diagnostic validity of precision injections, as well as their impact on surgical planning and outcomes. Diagnostic injections are discussed in terms of facet arthropathy, lumbar radiculopathy, discogenic pain and discography, and sacroiliac joint dysfunction. There is a growing body of evidence supporting the use of diagnostic local anesthetic injections or nerve blocks to aid in diagnosis. Spinal injections add valuable objective information that can potentially improve diagnostic precision, guide treatment strategies, and aid in patient selection for invasive surgical interventions.

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Ultrasound-guided cervical selective nerve root injections: a narrative review of literature

Cited by 8 publications

References 76 publications

(4-Aminopyridine)–PLGA–PEG as a Novel Thermosensitive and Locally Injectable Treatment for Acute Peripheral Nerve Injury

(4-Aminopyridine)–PLGA–PEG as a Novel Thermosensitive and Locally Injectable Treatment for Acute Peripheral Nerve Injury

2. Cervical radicular pain

The Role of Diagnostic Injections in Spinal Disorders: A Narrative Review

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