Cervical Ultrasound Utilization in Selective Cervical Nerve Root Injection for the Treatment of Cervical Radicular Pain: a Review

  • Reza Ehsanian
  • David J. Kennedy
  • Byron SchneiderEmail author
Musculoskeletal Rehabilitation (B Schneider, Section Editor)
Part of the following topical collections:
  1. Topical Collection on Musculoskeletal Rehabilitation


Purpose of Review

This paper aims to review the available literature addressing the safety, accuracy, and efficacy of ultrasound-guided injections for cervical radicular pain.

Recent Findings

Ultrasound-guided injections remain a “partially blind technique” due to the inability to visualize relevant structures and the distribution of injectate. There remains a need for adequately powered studies evaluating the safety, accuracy, and effectiveness of ultrasound-guided steroid injections in the cervical spine. Fluoroscopy remains the best evidence-based image-guidance modality for injections into the cervical epidural space to treat cervical radicular pain.


If ultrasound guidance is planned for treatment of cervical radicular pain, the authors recommend concomitant use of fluoroscopy guidance. Given the risk of inaccurate needle placement, physicians should retain fluoroscopic images prior to contrast injection to document the proper vertebral segment and final needle tip position. As epidural flow cannot be fully visualized with ultrasound, it is recommended to use fluoroscopy and, if needed, digital subtraction imaging to confirm the absence of intravascular injection. At a minimum, images should be saved post-contrast injection to document epidural flow.


Injection Ultrasound guided Fluoroscopic Fluoroscopy Cervical nerve root blocks Selective cervical nerve root block Epidural steroid injection Pain 



The authors would like to thank Ms. Heather E. Laferriere, MLIS, Health Sciences Informationist, Eskind Biomedical Library at Vanderbilt University for her help in the database review for relevant literature.

Compliance with Ethical Standards

Conflict of Interest

Reza Ehsanian, David Kennedy, and Byron Schneider declare that they have no conflict of interest.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by any of the authors.

Supplementary material

40141_2019_248_MOESM1_ESM.docx (42 kb)
ESM 1 (DOCX 42 kb)


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Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2019

Authors and Affiliations

  • Reza Ehsanian
    • 1
    • 2
    • 3
  • David J. Kennedy
    • 1
  • Byron Schneider
    • 1
    Email author
  1. 1.Department of Physical Medicine and RehabilitationVanderbilt UniversityNashvilleUSA
  2. 2.Department of NeurosurgeryStanford UniversityPalo AltoUSA
  3. 3.Division of Physical Medicine and Rehabilitation, Department of NeurosurgeryUniversity of New Mexico School of MedicineAlbuquerqueUSA

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