Ultrasound-guided versus fluoroscopy-guided lumbar selective nerve root block: a retrospective comparative study

Abstract

The purpose of this study is to compare the accuracy and effectiveness of ultrasound-guided and fluoroscopy-guided lumbar selective nerve root block (SNRB), and to explore the feasibility of ultrasound-guided methods. This retrospective study included patients with lumbar radicular pain who underwent ultrasound-guided and fluoroscopy-guided selective nerve root block at Honghui Hospital Affiliated to Xi'an Jiaotong University from August 2020 to August 2022. Patients were divided into U-SNRB group and F-SNRB group according to ultrasound-guided or fluoroscopy-guided selective nerve root block. There were 43 patients in U-SNRB group and 20 patients in F-SNRB group. The pain visual analogue scale (VAS) scores, Japanese Orthopaedic Association (JOA) scores, related indexes and complications were recorded and compared between the two groups before, 30 min, 1 month and 6 months after block. To evaluate the feasibility, accuracy and effectiveness of ultrasound-guided selective nerve root block. There were no complications in the process of selective nerve root block in both groups. The operating time and the times of closing needle angle adjustment in U-SNRB group were better than those in F-SNRB group, and the difference was statistically significant (P < 0.05). The VAS score and JOA score of patients in the two groups were significantly improved 30 min after block, 1 month and 6 months after block, and the difference was statistically significant (P < 0.05). There was no significant difference between the two groups (P > 0.05). The accuracy of ultrasound-guided selective nerve root block and the degree of pain relief of patients were similar to those of fluoroscopy guidance, but the operation time and needle angle adjustment times were significantly less than that of fluoroscopy, and could effectively reduce radiation exposure. Therefore, it can be used as a better way to guide for choice.

Keywords: Fluoroscopy; Lumbar radiculopathy; Selective nerve root block; Ultrasound.

Figure 1

X-ray verification picture: (A) the ultrasound equipment was placed in the X-ray examination room. The patient lies prone on the X-ray bed and the clothes are pulled up to expose the waist and back. (B) The planned block segments are marked on the body surface, and an X-ray marker is attached. (C) X-ray shows that the marker is in the correct position. (D) The block needle was placed under the guidance of ultrasound. (E) X-ray verification: the block needle is accurately in place.

Figure 2

Ultrasonic location picture: (A) The yellow arrow shows the spinous process. The red arrow shows the tip of the needle. The black arrow shows the nerve root. (B) The long axis of the ultrasonic probe is placed parallel to the long axis of the body, and the lumbar segments are identified by the sacrum in turn.