Ultrasound-guided selective nerve root block versus fluoroscopy-guided interlaminar epidural block for the treatment of radicular pain in the lower cervical spine: a retrospective comparative study
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Recent studies have compared the therapeutic efficacy and safety of the procedure using ultrasound and fluoroscopy. However, there are no published studies comparing the therapeutic efficacy and safety of fluoroscopy (FL)-guided cervical interlaminar epidural steroid injection (CIESI) with that of ultrasound (US)-guided selective nerve root block (SNRB). This study aimed to compare the mid-term effects and advantages of US-guided SNRB with FL-guided CIESI for radicular pain in the lower cervical spine through assessment of pain relief and functional improvement.
Patients with radicular pain in the lower cervical spine who received US-guided SNRB (n = 51) or FL-guided CIESI (n = 61) were included in this retrospective study. All procedures were performed using FL or US. The complication frequencies during the procedures, adverse events, treatment effects, and functional improvement were compared at intervals of 1, 3, and 6 months after the last injection.
Both the neck disability index and verbal numeric scale showed improvements at 1, 3, and 6 months after the last injection in both groups, with no significant differences between groups (p < 0.05). Furthermore, the treatment success rate at all time points was not significantly different between groups. Logistic regression analysis revealed that the injection method (US- or FL-guided), sex, analgesic use, pain duration, number of injections, and age were not independent predictors of treatment success. Blood was aspirated before injection in 8% (n = 5) and 0% of patients in the FL-guided and US-guided groups, respectively. In seven patients of the FL-guided group, intravascular contrast spread was noted during injection.
Our results suggest that, compared with FL-guided CIESI, US-guided SNRB requires a shorter administration duration while providing similar pain relief and functional improvements.
KeywordsUltrasound Fluoroscopy Injection Cervical
Compliance with ethical standards
Conflict of interest
The authors have no conflict of interest for this study.
Procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.
This study was a retrospective comparative review of chart data. Patient privacy and data confidentiality were maintained throughout the research process. The institutional review board of the corresponding author’s affiliated university approved the study. The approval included a waiver of informed consent, because the study did not include direct contact with the study population, and all patient identifiers were removed from the data set on the initial collection.
- 7.Johnson BA, Schellhas KP, Pollei SR (1999) Epidurography and therapeutic epidural injections: technical considerations and experience with 5334 cases. Am J Neuroradiol 20:697–705Google Scholar
- 8.Galiano K, Obwegeser AA, Bodner G et al (2005) Ultrasound-guided periradicular injections in the middle to lower cervical spine: an imaging study of a new approach. Reg Anesth Pain Med 30:391–396Google Scholar
- 14.Vernon H, Mior S (1991) The neck disability index: a study of reliability and validity. J Manip Physiol Ther 14:409–415Google Scholar
- 21.Ho KY (2006) Vascular uptake of contrast despite negative aspiration in interlaminar cervical epidural injection. Pain Physician 9:267–268Google Scholar
- 24.Kim YU, Kim D, Park JY, Choi JH, Kim JH, Bae HY, Joo EY, Suh JH (2016) Method to reduce the false-positive rate of loss of resistance in the cervical epidural region. Pain Res Manag 2016:9894054Google Scholar
- 30.Galiano K, Obwegeser AA, Walch C, Schatzer R, Ploner F, Gruber H (2007) Ultrasound-guided versus computed tomography-controlled facet joint injections in the lumbar spine: a prospective randomized clinical trial. Reg Anesth Pain Med 32:317–322Google Scholar
- 34.Chang-Chien GC, Knezevic NN, McCormick Z, Chu SK, Trescot AM, Candido KD (2014) Transforaminal versus interlaminar approaches to epidural steroid injections: a systematic review of comparative studies for lumbosacral radicular pain. Pain Physician 17:E509–E524Google Scholar