Ultrasound Guided Spine Injections: Advancement Over Fluoroscopic Guidance?

Patients with acute cholangitis require emergent biliary decompression. Those who are hemodynamically unstable on vasopressor support and mechanical ventilation are too critically ill to move outside of the intensive care unit. This prohibits performing Endoscopic Retrograde Cholangiopancreatography (ERCP) in the endoscopy unit. Fluoroscopic guidance is required to confirm deep biliary cannulation during ERCP. There are a few reported cases of bedside ERCP using portable C-arm fluoroscopy unit or ultrasound guided cannulation. We present a unique case of life-saving emergent bedside ERCP in a severely ill patient with cholangitis and septic shock, using simple portable X-ray to confirm biliary cannulation.

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Ultrasound-guided fluoroscopic-verified trans-foraminal lumbar dorsal root ganglion pulsed radiofrequency modulation for radicular pain relief: clinical and cadaveric evaluation of the technique

Egyptian Journal of Radiology and Nuclear Medicine ◽

10.1186/s43055-021-00416-1 ◽

2021 ◽

Vol 52 (1) ◽

Author(s):

Shaaban Omar ◽

Sherif El-Sayed Hegab ◽

Mohamed Ihab Samy Reda ◽

Sahar Ahmed El-Karadawy ◽

Mowaffak Moustafa Saad ◽

...

Keyword(s):

Dorsal Root Ganglion ◽

Dorsal Root ◽

Radicular Pain ◽

Lumbar Pain ◽

Lumbar Region ◽

Pulsed Radiofrequency ◽

Ultrasound Guided ◽

Sonographic Guidance ◽

Spine Injections ◽

Fluoroscopic Imaging

Abstract Background Ultrasound-guided lumbar pain interventions were thought to be difficult; the high acoustic impedance of bone hides the underling structures and needle path. Reviewing the sonoanatomy of the lumbar region using different planes and angles made better sonographic guidance for spine injections. The aim of this prospective study is to assess the accuracy and safety of ultrasound (US)-guided lumbar trans-foraminal pulsed radiofrequency of the dorsal root ganglion confirmed by fluoroscopic imaging in management of chronic radicular pain. Results Thirty-two patients, with 34 lumbar interventions, were included in the study. Thirty-one interventions out of 34 were performed successfully with overall accuracy of 91.18% and with minimal complications. The successful first trial placement of the cannula was calculated in 44.1% of interventions; multiple trials were needed in 47.1% while incorrect level was encountered in 8.8%. Visual analogue scale of pain and Oswestry Disability Index decreased significantly after intervention up to 3 months compared to the pre-intervention value. The analgesic consumption was reduced by mean of 73.44 ± 31.07% 1 month after intervention. Conclusions US-guided fluoroscopic-verified trans-foraminal PR of lumbar DRG is accurate, safe, and effective for CRP.

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Success Rate of Intra-articular Sacroiliac Joint Injection: Fluoroscopy vs Ultrasound Guidance—A Cadaveric Study

Pain Medicine ◽

10.1093/pm/pnz059 ◽

2019 ◽

Vol 20 (10) ◽

pp. 1890-1897 ◽

Cited By ~ 5

Author(s):

Wolfgang Stelzer ◽

Dominik Stelzer ◽

Elisabeth Stelzer ◽

Andreas Sammer ◽

Elisabeth Aichner ◽

...

Keyword(s):

Success Rate ◽

Sacroiliac Joint ◽

Ultrasound Guidance ◽

Subjective Feeling ◽

Fluoroscopic Guidance ◽

Joint Injection ◽

Cadaver Dissection ◽

Ultrasound Guided ◽

The Real ◽

Image Guided

Abstract Background Given the unacceptably high miss rates of non-image-guided injections into the sacroiliac joint, either fluoroscopy or ultrasound is recommended for guidance. The real success rate of both techniques was assessed by cadaver dissection. Methods Twenty bodies donated to science (40 joints: 15 female and 5 male) were investigated bilaterally. Fluoroscopy and a lower ultrasound-guided approach were performed in 10 bodies each. Conditions during puncture, the subjective feeling of the needle being intra-articular, and, for fluoroscopic guidance, the intra-articular spread of the contrast were assessed. First, 0.5 cc of Iopamidol was injected, followed by 2 mL of red-colored latex. The spread was investigated by dissection via anterior opening of the sacroiliac joint and the dorsal ligaments. Results Ultrasound guidance was used in 1/20 (5%, 95% CI = 0.9–23.6%) intra-articular injections. In 19/20 (95%, 95% CI = 0.9–23.6%) cases, latex spread in the interosseous sacroiliac ligament was used. Conditions of structural visibility were classified as good in 11/20 (55%, 95% CI = 34.2–74.2%) cases, puncture condition as good in 16/20 (80%, 95% CI = 58.4–91.9%) cases, and subjective feeling of the needle being intra-articular was present in 10/20 (50%, 95% CI = 34.2–74.2%) cases. Fluoroscopy showed an intra-articular injection in 10/20 (50%, 95% CI = 34.2–74.2%) cases. The structure visibility in fluoroscopy was good in 9/20 (45%, 95% CI = 25.8–65.8%), puncture conditions good in 8/20 (40%, 95% CI = 21.9–61.3%), intra-articular contrast spread visible in 10/20 (50%, 95% CI = 34.2–74.2%), and subjective feeling of being intra-articular was present in 17/20 (85%, 95% CI = 64.0–94.8%) cases. Conclusions Fluoroscopy clearly showed a higher success rate of intra-articular sacroiliac joint injection.

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Ultrasound-guided total dorsal ramus block for the treatment of chronic low back pain

Journal of Orthopaedics Trauma and Rehabilitation ◽

10.1177/2210491720928505 ◽

2020 ◽

Vol 27 (2) ◽

pp. 128-132

Author(s):

Ryota Kimura ◽

Naohisa Miyakoshi ◽

Yusuke Yuasa ◽

Yoichi Shimada

Keyword(s):

Low Back Pain ◽

Back Pain ◽

Adverse Events ◽

Radiation Exposure ◽

Chronic Low Back Pain ◽

Ultrasound Guidance ◽

Pain Reduction ◽

Low Back ◽

Fluoroscopic Guidance ◽

Ultrasound Guided

Background: To reduce the risk of radiation exposure, we explored whether the total dorsal ramus block can be performed under ultrasound guidance. We evaluated the accuracy and effect of ultrasound-guided total dorsal ramus block for chronic low back pain. Methods: Accuracy of ultrasound guidance after total dorsal ramus block to the L4–L5 level was evaluated using fluoroscopy ( n = 5). A second group was assigned into two groups: ultrasound-guided group ( n = 19) or fluoroscopy-guided group ( n = 18). The effects and adverse events were compared. Results: In all cases, the fluoroscopic findings revealed an accurate injection at the L5 level. Significant alleviation of pain was observed after ultrasound-guided total dorsal ramus block, and comparable effectiveness was observed with both ultrasound guidance and fluoroscopic guidance. There were no complications. Conclusions: The ultrasound-guided total dorsal ramus block may sufficiently block all three branches of the lumbar dorsal ramus at the targeted level resulting in significant pain reduction.

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