Ultrasound-guided versus computed tomography-controlled periradicular injections in the middle and lower cervical spine: a prospective randomized clinical trial

Abstract

Purpose We conducted this study to evaluate accuracy, time saving, radiation doses, safety, and pain relief of ultrasound (US)-guided periradicular injections versus computed tomography (CT)-controlled interventions in the cervical spine in a prospective randomized clinical trial. Methods Forty adult patients were consecutively enrolled and randomly assigned to either a US or a CT group. USguided periradicular injections were performed on a standard ultrasound device using a broadband linear array transducer. By basically following the osseous landmarks for level definition in ''in-plane techniques'', a spinal needle was advanced as near as possible to the intended, US-depicted nerve root. The respective needle tip positioning was then verified by CT. The control group underwent CT-guided injections, which were performed under standardized procedures using the CT-positioning laser function. Results The accuracy of US-guided interventions was 100 %. The mean time to final needle placement in the US group was 02:21 ± 01:43 min:s versus 10:33 ± 02:30 min:s in the CT group. The mean dose-length product radiation dose, including CT confirmation for study purposes only, was 25.1 ± 16.8 mGy cm for the US group and 132.5 ± 78.4 mGy cm for the CT group. Both groups showed the same significant visual analog scale decay (p \ 0.05) without ''inter-methodic'' differences of pain relief (p [ 0.05). Conclusions US-guided periradicular injections are accurate, result in a significant reduction of procedure expenditure under the avoidance of radiation and show the same therapeutic effect as CT-guided periradicular injections.

Use of Autologous Serum in Treatment of Lumbar Radiculopathy Pain. Pilot Study

“…Licz ne pu bli ka cje pod kre śla ją wy so ką sku tecz ność tech ni ki ul tra so no gra ficz nej kon tro li in iek cji oko ło krę go wych, pod kre śla jąc jedno cze śnie ich bez pie czeń stwo i brak ró żnic w wy nikach le cze nia. Dzię ki znacz nej zbie żno ści kost nych mar ke rów ana to micz nych ob ser wo wa nych w USG z prze kro ja mi CT i ba da nia mi sek cyj ny mi, in iek cje oko ło krę go we wy ko ny wa ne pod kon tro lą USG charak te ry zu ją się wy star cza ją cą do kład no ścią i wia rygod no ścią lo ka li za cji igły w opar ciu o cha rak te rystycz ne prze kro je ob ry sów kost nych [22,23]. W ni niejszym opra co wa niu te ra pia bio lo gicz na ACS utrzy muje swo ją sku tecz ność na wet po 3 mie sią cach od po dania ostat niej daw ki su ro wi cy, w od ró żnie niu od te ra pii ste ry do wej, gdzie zgod nie z far ma ko dy na mi ką pre para tów ob ser wu je się za nik efek tu prze ciw bó lo we go i prze ciw o brzę ko we go już po 3 do 6 ty go dniach.…”

“…Numerous publications stress the high efficacy of ultrasound guidance of perivertebral injections, pointing out their safety and the lack of differences in treatment outcomes. Due to the considerable similarity between ana tomical bone landmarks observed in an ultra sound study and those found on CT cross-sections and in autopsy examinations, perivertebral injections performed under ultrasound guidance are characterised by sufficient accuracy and reliability of needle location based on characteristic bone outline cross-sections [22,23]. In the present study, the efficacy of the biological therapy with ACS was maintained even at 3 months after the administration of the last dose of the serum, as opposed to steroid therapy, where, in accordance with the pharmacodynamics of the preparations, the analgesic and anti-inflammatory effects wear off after 3-6 weeks.…”

The Michel Benoist and Robert Mulholland Yearly European Spine Journal Review: a survey of the “surgical and research” articles in the European Spine Journal, 2013

“…There is increasing concern about the effects of radiation now that various MISS procedures are increasingly used, so the paper by Obernauer et al [57] reporting a prospective randomised trial comparing the use of ultrasound with CT guided periradicular injections in the middle and lower cervical spine is of some interest. The needle was guided by ultrasound, and the final position verified by CT in one group, and in the other CT was used throughout the procedure.…”

Localized cervical pain: advantages and limits of ultrasound evaluation

“…In particular, according to several authors [12][13][14][15][16], US is at least sufficiently reliable and accurate in the demonstration of cervical paravertebral anatomy, facilitating the localization and imaging of muscles, superficial ligaments, spinal nerve roots, vessels, as well as bony landmarks and interarticular space of facet and articular joints. 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].…”