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. 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.

Fig. 1

US-guided periradicular injection for the 6th cervical nerve root (a); at tuberculum anterior, pt tuberculum posterior, ARROW needle pathway, C6 6th nerve root, *detected vessel; and CT control (b)

Fig. 2

Illustration showing sonographer′s hand position and the placement of the spinal needle—inserted from dorsal exactly within the scanning plane of the US probe (▼)

Fig. 3

CT-guided periradicular injection for the 7th cervical nerve root. a CT scout with radio-opaque marker on patient′s skin and CT localizer at the level C6/7. b Calculations of point of entry, the angle and depth of the approach. c Control scan after final needle placement showing needle tip