Ultrasound-Guided Cervical Spine Injections

Narouze, Samer

doi:10.1097/aap.0b013e31823f3c80

Cited by 44 publications

(17 citation statements)

References 18 publications

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“…The ability to identify and avoid vessels in the trajectory of the needle is an important advantage of US-guided cervical spine interventions 30,36,37,38 . Cohen et al reported a 7% incidence of unintentional intravascular injections during fluoroscopically guided CMBBs 39 .…”

Section: Discussionmentioning

confidence: 99%

“…Cohen et al reported a 7% incidence of unintentional intravascular injections during fluoroscopically guided CMBBs 39 . Ultrasonography is a valuable tool for detecting and, hence, preventing vascular injury during CMBBs, whereas contrast fluoroscopy can only demonstrate that the tip of the needle is intravascular, after the penetration of the vessel 37 . Cervical vessel penetration and/or injection can cause intravascular thrombosis 40 and other potentially life-threatening complications, including stroke 41,42,43 .…”

Section: Discussionmentioning

confidence: 99%

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Ultrasound-Guided Cervical Medial Branch Blocks: A Systematic Review and Meta-Analysis

Souza

2020

AHM Journal

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Objective: Cervical medial branch blocks (CMBBs) are useful in differentiating facetogenic pain from other sources of cervicogenic headaches and neck pain. The purpose of this systematic review and meta-analysis is to determine the efficacy, performance time, pain reduction, and adverse events associated with ultrasound (US) guided CMBB compared with other commonly used guidance methods such as fluoroscopy and computed tomography (CT). Methods: Searches of MEDLINE, EMBASE, Cochrane Library, and Ovid were completed to identify studies addressing CMBBs utilizing ultrasound compared to other imaging techniques. Three reviewers independently screened the titles, abstracts, and full texts, extracting data from eligible studies. Outcomes of interest including success rate, efficacy, performance time and complication profile were analyzed in meta-analysis. All other reported measures and complication profiles were analyzed descriptively. Results: A total of 9 studies were included. Four randomized controlled trials (RCTs) and 5 cohort studies satisfied inclusion criteria. US-guided CMBBs demonstrated similar success rates (OR = 1.05, 95% CI = 0.15 to 7.52, z = 0.05, P = 0.96) and similar pain efficacy (SMD = -0.54, 95% CI = -1.91 to 0.83, z = - 0.77, P = 0.44) compared to traditional guidance techniques. However, US-guided CMBBs demonstrated reduced performance time (SMD = -1.77, 95% CI = -2.65 to -0.89, z = -3.94, P <0.01) and rate of vascular injury/injection (OR = 0.09, 95% CI = 0.01 to 0.75, z = -2.23, P = 0.03) compared to fluoroscopy guided CMBBs. Conclusion: This review and meta-analysis demonstrated that US-guided cervical medial branch blocks are a reliable alternative to fluoroscopy- and CT-guided CMBBs, with similar efficacy but a potentially improved safety and performance time.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Ultrasound-Guided Cervical Medial Branch Blocks: A Systematic Review and Meta-Analysis

Souza

2020

AHM Journal

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“…This is of clinical relevance because these structures can possibly be used as ''imaging'' landmark for therapeutic purposes [14][15][16][17] as demonstrated while performing image-guided injections (for nerves or articular pathologies) of the cervical spine [18,19]. In particular, it has been reported that US, when compared to fluoroscopy or CT, is an excellent tool for ''visualizing'' (accuracy 68-100 %) and hence ''avoiding'' vascular injury during interventional procedures [18], whereas fluoroscopy can only ''detect'' that the tip of the needle is intravascular (after the fact) [20]. Moreover, US reduces the timing of the procedure and avoids radiation both for the patient and the operator.…”

Section: Discussionmentioning

confidence: 99%

“…In this regard, it is well known that excessive facet joint compression and capsular ligament strain arising after whiplash injury or neck trauma [11,21] and/or facet joint degeneration, found more commonly in the elderly, can stimulate the nociceptive elements (free and encapsulated nerve endings, nociceptors, and mechanoceptors) contained in the facet joint and capsule [22,23]. These structures, which are innervated by the medial branches of the dorsal rami [24], may also be responsible for cervicogenic headaches (C2-C3 facet joint) and/or pain in the suboccipital region [11,20]. On the other hand, it must be underlined that in a significant percentage of patients (54.3 %, 69/127), US examination did not reveal any evident cervical spine abnormality.…”

Section: Discussionmentioning

confidence: 99%

Localized cervical pain: advantages and limits of ultrasound evaluation

Galletti

Schiavone

et al. 2016

J Ultrasound

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“…All sonographic examinations were performed using a Philips HD15 equipped with a linear probe. US was performed with the volunteers in two postures, i.e., 1) supine position with the neck slightly extended, and the head rotated slightly to the opposite side to be blocked [ 2 3 4 5 ] [ 3 4 ], and 2) lateral decubitus position with the side to be treated uppermost [ 4 5 6 ] ( Fig. 1 ).…”

Section: Methodsmentioning

confidence: 99%

Sonoanatomical Change of Phrenic Nerve According to Posture During Ultrasound-Guided Stellate Ganglion Block

et al. 2016

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ObjectiveTo evaluate the risk of phrenic nerve injury during ultrasound-guided stellate ganglion block (US-SGB) according to sonoanatomy of the phrenic nerve, and determine a safer posture for needle insertion by assessing its relationship with surrounding structure according to positional change.MethodsTwenty-nine healthy volunteers were recruited and underwent ultrasound in two postures, i.e., supine position with the neck extension and head rotation, and lateral decubitus position. The transducer was placed at the anterior tubercle of the C6 level to identify phrenic nerve. The cross-sectional area (CSA), depth from skin, distance between phrenic nerve and anterior tubercle of C6 transverse process, and the angle formed by anterior tubercle, posterior tubercle and phrenic nerve were measured.ResultsThe phrenic nerve was clearly identified in the intermuscular fascia layer between the anterior scalene and sternocleidomastoid muscles. The distance between the phrenic nerve and anterior tubercle was 10.33±3.20 mm with the supine position and 9.20±3.31 mm with the lateral decubitus position, respectively. The mean CSA and skin depth of phrenic nerve were not statistically different between the two positions. The angle with the supine position was 48.37°±27.43°, and 58.89°±30.02° with the lateral decubitus position. The difference of angle between the two positions was statistically significant.ConclusionUltrasound is a useful tool for assessing the phrenic nerve and its anatomical relation with other cervical structures. In addition, lateral decubitus position seems to be safer by providing wider angle for needle insertion than the supine position in US-SGB.

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Ultrasound-Guided Cervical Spine Injections

Cited by 44 publications

References 18 publications

Ultrasound-Guided Cervical Medial Branch Blocks: A Systematic Review and Meta-Analysis

Ultrasound-Guided Cervical Medial Branch Blocks: A Systematic Review and Meta-Analysis

Localized cervical pain: advantages and limits of ultrasound evaluation

Sonoanatomical Change of Phrenic Nerve According to Posture During Ultrasound-Guided Stellate Ganglion Block

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