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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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Abstract

Purpose

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.

Methods

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.

Results

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.

Conclusions

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.

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Author information

Author notes

  1. Ki Deok Park and Woo Yong Lee have contributed equally as a first author to this work.

Authors and Affiliations

  1. Department of Rehabilitation Medicine, Gachon University, Gil Medical Center, Incheon, South Korea

    Ki Deok Park

  2. Department of Anesthesiology, Sanggye Paik Hospital, Inje University College of Medicine, Seoul, South Korea

    Woo Yong Lee

  3. Department of Plastic and Reconstructive Surgery, Sanggye Paik Hospital, Inje University College of Medicine, Seoul, South Korea

    Sang Hyun Nam

  4. Department of Obstetrics and Gynecology, Sanggye Paik Hospital, Inje University College of Medicine, Seoul, South Korea

    Myounghwan Kim

  5. Department of Physical Medicine and Rehabilitation, Sanggye Paik Hospital, Inje University College of Medicine, Sanggye 7 dong 761-7, Nowon-gu, 139-707, Seoul, South Korea

    Yongbum Park

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  1. Ki Deok Park
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Correspondence to Yongbum Park.

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Conflict of interest

The authors have no conflict of interest for this study.

Ethical statement

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.

Informed consent

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.

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Park, K.D., Lee, W.Y., Nam, S.H. et al. 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. J Ultrasound 22, 167–177 (2019). https://doi.org/10.1007/s40477-018-0344-z

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  • DOI: https://doi.org/10.1007/s40477-018-0344-z

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