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Accuracy of non-guided versus ultrasound-guided injections in cervical muscles: a cadaver study

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Abstract

Introduction

The col-cap concept encouraged neurologists to inject a large group of muscles in the treatment of cervical dystonia. This includes deep muscles such as the obliquus capitis inferior or the semispinalis capitis, and muscles close to vascular or neurological structures such as scalene muscles. Our aim was to determine the accuracy of injections in cervical muscles using ultrasonography (US) or palpation of anatomical landmarks.

Methods

A mix of paint, gelatin and iodized contrast agent was injected in nine pairs of cervical muscles of human cadavers, according to two injection techniques: US-guided and non-guided. The dye was localized on 1 cm-thick, frozen slices.

Results

A total of 102 muscles was injected in the US-guided group (n = 8). The global accuracy was 88.2%. The lowest accuracy was in the OCI (41.7%); trying to avoid the vertebral artery, injections were too medial. A total of 54 muscles was injected in the non-guided group (n = 3). The global accuracy was 48.0%; moreover, some dye was found in four blood vessels. The embalming process produced texture changes, making difficult the palpation of bony landmarks.

Conclusions

Our results indicate that US-guided injections are more accurate than non-guided injections in most cervical muscles.

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Data availability

The data that support the findings of this study are available from the corresponding author upon reasonable request.

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Acknowledgements

All the authors would like to warmly thank Pr. Wolgang Jost (Parkinson-Klinik Ortenau, Kreuzbergstr. 12, 77709 Wolfach, Germany) for his teaching. His help was essential when we decided to use ultrasonography in the treatment of cervical dystonia.

Funding

This research did not receive any specific funding from agencies or organizations in the public, commercial, or not-for-profit sectors.

Author information

Authors and Affiliations

  1. CHU Lille, Neurologie et Pathologie du Mouvement, F-59000, Lille, France

    Alexandre Kreisler, Camille Gerrebout & Luc Defebvre

  2. CHU Lille, Radiologie et Imagerie Musculo-squelettique, F-59000, Lille, France

    Xavier Demondion

  3. Department of Anatomy and Organogenesis, Univ. Lille, F-59045, Lille, France

    Xavier Demondion

  4. CHU Lille, ULR 7367 - UTML&A - Unité de Taphonomie Médico-Légale et d’Anatomie, Univ. Lille, F-59000, Lille, France

    Xavier Demondion

Authors
  1. Alexandre Kreisler
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  2. Camille Gerrebout
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  3. Luc Defebvre
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  4. Xavier Demondion
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Contributions

XD, AK and CG Conceptualization. XD, AK and CG Methodology. AK, with the assistance of CG and XD Injections. CG, AK and XD Data acquisition. AK Statistics. AK Writing—original draft preparation. XD, LD and CG Writing—review and editing. XD and LD Resources. LD Supervision.

Corresponding author

Correspondence to Alexandre Kreisler.

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Conflicts of interest

Dr. Kreisler reports personal fees from Allergan France, Merz Pharma France, and Ipsen France, outside the submitted work. Dr. Gerrebout has nothing to disclose. Pr. Defebvre has nothing to disclose. Pr. Demondion has nothing to disclose.

Ethical approval

The use of cadavers for research does not require specific approval by the ethics committee.

Informed consent to participate

The cadavers were donated for research and education on human anatomy.

Informed consent for publication

The cadavers were donated for research and education on human anatomy.

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Kreisler, A., Gerrebout, C., Defebvre, L. et al. Accuracy of non-guided versus ultrasound-guided injections in cervical muscles: a cadaver study. J Neurol 268, 1894–1902 (2021). https://doi.org/10.1007/s00415-020-10365-w

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  • DOI: https://doi.org/10.1007/s00415-020-10365-w

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