Ultrasound-guided selective nerve root block versus fluoroscopy-guided transforaminal block for the treatment of radicular pain in the lower cervical spine: A randomized, blinded, controlled study

Jee, Haemi; Lee, Ji Hae; Kim, Jong-Woo; Park, Ki Deok; Lee, Woo Yong; Park, Yongbum

doi:10.1007/s00256-012-1434-1

Cited by 94 publications

(105 citation statements)

References 34 publications

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“…A technique of selective nerve root block has been described and found to be feasible and safe but accuracy was noted to be poor compared to fluoroscopy [41]. This is in contrast to a study by Jee et al [42] who evaluated the efficacy of ultrasound-guided selective nerve root block with transforaminal epidural steroid injection and found no difference in outcomes.…”

Section: Pain Medicinecontrasting

confidence: 55%

Musculoskeletal Ultrasound in Physical Medicine and Rehabilitation

Deimel

Jelsing

Hall

2013

Curr Phys Med Rehabil Rep

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Section: Pain Medicinecontrasting

confidence: 55%

Musculoskeletal Ultrasound in Physical Medicine and Rehabilitation

Deimel

Jelsing

Hall

2013

Curr Phys Med Rehabil Rep

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“…In addition, US significantly reduced procedure time. Jee et al [34] conducted a randomized, blinded controlled study of 120 patients with similar results. The majority of the studies were designed to assess feasibility of injection in the middle to lower cervical spine only [5,22,34].…”

Section: Cervical Epidural Steroid Injectionsmentioning

confidence: 73%

Ultrasound-Guided Interventional Procedures for Chronic Pain Management

et al. 2015

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Ultrasonography has multiple advantages over traditional radiologic imaging modalities when used for interventional procedures. It allows improved visualization of the anatomy while avoiding ionizing radiation and risks associated with contrast use. It has proved superiority at accuracy of delivery and procedural effectiveness over blind procedures when used in association with interventional pain procedures. Although limited in its ability to see through bony structures, ultrasound has utility in visualizing soft tissues and vascular structures in anatomic regions of interest resulting in increased use for posterior neuraxial, periaxial, peripheral nerve and joint-related structures. Current evidence for use in these settings is presented here. In some cases, optimal utility may be improved by combining ultrasonography with other imaging modalities. KEYWORDS• chronic pain management Advantages of ultrasound imagingInterventional pain procedures were traditionally performed under fluoroscopic (FS), computed tomography (CT) or MRI guidance. The use of ultrasound (US) to perform injections for chronic pain has significantly increased in the past decade [1,2]. This increase is attributed to its multiple advantages over other imaging modalities including ease of performance, absence of ionizing radiation, better visualization of soft tissue (i.e., muscle, ligament) and blood vessels, real time visualization of needle advancement and, at times, the ability to observe the spread of injectate [3]. US Practice points• Use of ultrasound in medicine has grown with smaller size equipment, increased portability and decreased cost.• Ultrasound has multiple advantages over radiographic imaging when used for interventional pain procedures.• Sonography is useful for medial branch blocks and intra-articular facet blocks in the cervical and lumbar spine but there is little evidence to support its use in the thoracic spine.• Ultrasonography is limited in utility for many types of axial injections because of bony and acoustic shadowing artifact but it does show some promise with transforaminal epidurals or selective nerve root blocks.• Ultrasound guidance is effective in preventing soft tissue and vascular injury in stellate ganglion blocks compared with blind techniques. Soft tissue and vascular anomalies can be identified that fluoroscopic technique will miss.• Ultrasound improves accuracy and efficacy in ilioinguinal, iliohypogastric and genitofemoral blocks for inguinal and testicular pain.• Lateral femoral cutaneous nerve injections are more accurate under ultrasound guidance, especially given the anatomic variation the nerve exhibits in cadaver dissections.• Injections into the knee, shoulder and hip joints are more successful when performed using ultrasound.For reprint orders, please contact: reprints@futuremedicine.com

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“…Sonographic treatment guidance has become established as an alternative method that also does not require radiation exposure or contrast agents. Like MRI compared to CT fluoroscopy, this allows significantly better soft tissue contrast and precise visualization of sensitive structures like the vertebral artery and is primarily suitable for injections in the lower cervical spine segments [41,42]. Exact guidance and localization of the injection cannula increases the safety for the patient.…”

Section: Discussionmentioning

confidence: 99%

MRI-Guided and CT-Guided Cervical Nerve Root Infiltration Therapy: A Cost Comparison

Maurer

Froeling

Röttgen

et al. 2013

Fortschr Röntgenstr

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Purpose: To evaluate and compare the costs of MRI-guided and CT-guided cervical nerve root infiltration for the minimally invasive treatment of radicular neck pain. Materials and Methods: Between September 2009 and April 2012, 22 patients (9 men, 13 women; mean age: 48.2 years) underwent MRI-guided (1.0 Tesla, Panorama HFO, Philips) single-site periradicular cervical nerve root infiltration with 40?mg triamcinolone acetonide. A further 64 patients (34 men, 30 women; mean age: 50.3 years) were treated under CT fluoroscopic guidance (Somatom Definition 64, Siemens). The mean overall costs were calculated as the sum of the prorated costs of equipment use (purchase, depreciation, maintenance, and energy costs), personnel costs and expenditure for disposables that were identified for MRI- and CT-guided procedures. Additionally, the cost of ultrasound guidance was calculated. Results: The mean intervention time was 24.9 min. (range: 12???36?min.) for MRI-guided infiltration and 19.7?min. (range: 5???54?min.) for CT-guided infiltration. The average total costs per patient were EUR 240 for MRI-guided interventions and EUR 124 for CT-guided interventions. These were (MRI/CT guidance) EUR 150/60 for equipment use, EUR 46/40 for personnel, and EUR 44/25 for disposables. The mean overall cost of ultrasound guidance was EUR 76. Conclusion: Cervical nerve root infiltration using MRI guidance is still about twice as expensive as infiltration using CT guidance. However, since it does not involve radiation exposure for patients and personnel, MRI-guided nerve root infiltration may become a promising alternative to the CT-guided procedure, especially since a further price decrease is expected for MRI devices and MR-compatible disposables. In contrast, ultrasound remains the less expensive method for nerve root infiltration guidance. Citation Format: ??Maurer MH, Froeling V, R?ttgen R et?al. MRI-Guided and CT-Guided Cervical Nerve Root Infiltration Therapy: A Cost Comparison. Fortschr R?ntgenstr 2014; 186: 559???566

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Ultrasound-guided selective nerve root block versus fluoroscopy-guided transforaminal block for the treatment of radicular pain in the lower cervical spine: A randomized, blinded, controlled study

Cited by 94 publications

References 34 publications

Musculoskeletal Ultrasound in Physical Medicine and Rehabilitation

Musculoskeletal Ultrasound in Physical Medicine and Rehabilitation

Ultrasound-Guided Interventional Procedures for Chronic Pain Management

MRI-Guided and CT-Guided Cervical Nerve Root Infiltration Therapy: A Cost Comparison

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