Skip to main content
SpringerLink
Log in

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

  • Original Article
  • Published:
European Spine Journal Aims and scope Submit manuscript

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. US-guided 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.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others

References

  1. Smith MD (1995) Cervical radiculopathy: causes and surgical treatment. Minn Med 78:28–50

    PubMed  CAS  Google Scholar 

  2. Cyteval C, Thomas E, Decoux E, Sarrabere MP, Cottin A, Blotman F, Taourel P (2004) Cervical radiculopathy: open study on percutaneous periradicular foraminal steroid infiltration performed under CT control in 30 patients. AJNR Am J Neuroradiol 25:441–445

    PubMed  Google Scholar 

  3. Ellenberg MR, Honet JC, Treanor WJ (1994) Cervical radiculopathy. Arch Phys Med Rehabil 75:342–352

    Article  PubMed  CAS  Google Scholar 

  4. Van Zundert J, Huntoon M, Patijn J, Lataster A, Mekhail N, van Kleef M (2010) 4. Cervical radicular pain. Pain Pract 10:1–17

    Article  PubMed  Google Scholar 

  5. Benny B, Azari P, Briones D (2010) Complications of cervical transforaminal epidural steroid injections. Am J Phys Med Rehabil 89:601–607

    Article  PubMed  Google Scholar 

  6. Vallee JN, Feydy A, Carlier RY, Mutschler C, Mompoint D, Vallee CA (2001) Chronic cervical radiculopathy: lateral-approach periradicular corticosteroid injection. Radiology 218:886–892

    Article  PubMed  CAS  Google Scholar 

  7. Galiano K, Obwegeser AA, Bodner G, Freund M, Maurer H, Kamelger FS, Schatzer R, Ploner F (2005) Real-time sonographic imaging for periradicular injections in the lumbar spine: a sonographic anatomic study of a new technique. J Ultrasound Med 24:33–38

    PubMed  Google Scholar 

  8. Loizides A, Gruber H, Peer S, Brenner E, Galiano K, Obernauer J (2011) A new simplified sonographic approach for pararadicular injections in the lumbar spine: a CT-controlled cadaver study. AJNR Am J Neuroradiol 32:828–831

    Article  PubMed  CAS  Google Scholar 

  9. Loizides A, Gruber H, Peer S, Galiano K, Bale R, Obernauer J (2013) Ultrasound guided versus CT-controlled pararadicular injections in the lumbar spine: a prospective randomized clinical trial. AJNR Am J Neuroradiol 34:466–470

    Article  PubMed  CAS  Google Scholar 

  10. Galiano K, Obwegeser AA, Bodner G, Freund MC, Gruber H, Maurer H, Schatzer R, Fiegele T, Ploner F (2006) Ultrasound-guided facet joint injections in the middle to lower cervical spine: a CT-controlled sonoanatomic study. Clin J Pain 22:538–543

    Article  PubMed  Google Scholar 

  11. Galiano K, Obwegeser AA, Bodner G, Freund M, Maurer H, Kamelger FS, Schatzer R, Ploner F (2005) Ultrasound guidance for facet joint injections in the lumbar spine: a computed tomography-controlled feasibility study. Anesth Analg 101:579–583 (table)

    Article  PubMed  Google Scholar 

  12. Galiano K, Obwegeser AA, Bodner G, Freund MC, Gruber H, Maurer H, Schatzer R, Ploner F (2005) Ultrasound-guided periradicular injections in the middle to lower cervical spine: an imaging study of a new approach. Reg Anesth Pain Med 30:391–396

    PubMed  Google Scholar 

  13. Narouze SN (2006) Ultrasound-guided cervical periradicular injection: cautious optimism. Reg Anesth Pain Med 31:87–88

    PubMed  Google Scholar 

  14. Narouze SN, Vydyanathan A, Kapural L, Sessler DI, Mekhail N (2009) Ultrasound-guided cervical selective nerve root block: a fluoroscopy-controlled feasibility study. Reg Anesth Pain Med 34:343–348

    Article  PubMed  Google Scholar 

  15. Gofeld M (2008) Ultrasonography in pain medicine: a critical review. Pain Pract 8:226–240

    Article  PubMed  Google Scholar 

  16. Lachin JM (2000) Statistical considerations in the intent-to-treat principle. Control Clin Trials 21:167–189

    Article  PubMed  CAS  Google Scholar 

  17. McLean JP, Sigler JD, Plastaras CT, Garvan CW, Rittenberg JD (2009) The rate of detection of intravascular injection in cervical transforaminal epidural steroid injections with and without digital subtraction angiography. PMR 1:636–642

    Google Scholar 

  18. Jasper JF (2003) Role of digital subtraction fluoroscopic imaging in detecting intravascular injections. Pain Physician 6:369–372

    PubMed  Google Scholar 

  19. Verrills P, Nowesenitz G, Barnard A (2010) Penetration of a cervical radicular artery during a transforaminal epidural injection. Pain Med 11:229–231

    Article  PubMed  Google Scholar 

  20. Windsor RE, Storm S, Sugar R, Nagula D (2003) Cervical transforaminal injection: review of the literature, complications, and a suggested technique. Pain Physician 6:457–465

    PubMed  Google Scholar 

  21. Baker R, Dreyfuss P, Mercer S, Bogduk N (2003) Cervical transforaminal injection of corticosteroids into a radicular artery: a possible mechanism for spinal cord injury. Pain 103:211–215

    Article  PubMed  Google Scholar 

  22. Huntoon MA (2005) Anatomy of the cervical intervertebral foramina: vulnerable arteries and ischemic neurologic injuries after transforaminal epidural injections. Pain 117:104–111

    Article  PubMed  Google Scholar 

  23. Brouwers PJ, Kottink EJ, Simon MA, Prevo RL (2001) A cervical anterior spinal artery syndrome after diagnostic blockade of the right C6-nerve root. Pain 91:397–399

    Article  PubMed  CAS  Google Scholar 

  24. Narouze SN (2012) Ultrasound-guided cervical spine injections: ultrasound “prevents” whereas contrast fluoroscopy “detects” intravascular injections. Reg Anesth Pain Med 37:127–130

    Article  PubMed  Google Scholar 

  25. Carrino JA, Morrison WB, Parker L, Schweitzer ME, Levin DC, Sunshine JH (2002) Spinal injection procedures: volume, provider distribution, and reimbursement in the U.S. medicare population from 1993 to 1999. Radiology 225:723–729

    Article  PubMed  Google Scholar 

Download references

Acknowledgments

The authors declare that no funds have been received in support of this study. No benefits in any form have been or will be received from a commercial party related directly or indirectly to the subject of this article.

Conflict of interest

The authors declare that there are no conflicts of interest.

Author information

Authors and Affiliations

  1. Department of Neurosurgery, Innsbruck Medical University, Anichstrasse 35, 6020, Innsbruck, Austria

    Jochen Obernauer & Alois Albert Obwegeser

  2. Innsbruck Medical University, Anichstrasse 35, 6020, Innsbruck, Austria

    Klaus Galiano

  3. WIK (Spine Center Innsbruck), Sanatorium Kettenbrücke, Sennstraße 1, 6020, Innsbruck, Austria

    Klaus Galiano

  4. Department of Radiology, Innsbruck Medical University, Anichstrasse 35, 6020, Innsbruck, Austria

    Hannes Gruber, Reto Bale & Alexander Loizides

  5. C. Doppler Laboratory for Active Implantable Systems, Institute of Ion and Applied Physics, University of Innsbruck, Technikerstrasse 25, 6020, Innsbruck, Austria

    Reinhold Schatzer

Authors
  1. Jochen Obernauer
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Klaus Galiano
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Hannes Gruber
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Reto Bale
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Alois Albert Obwegeser
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Reinhold Schatzer
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Alexander Loizides
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Jochen Obernauer.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Obernauer, J., Galiano, K., Gruber, H. et al. Ultrasound-guided versus computed tomography-controlled periradicular injections in the middle and lower cervical spine: a prospective randomized clinical trial. Eur Spine J 22, 2532–2537 (2013). https://doi.org/10.1007/s00586-013-2916-0

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00586-013-2916-0

Keywords

Search

Navigation