Effectiveness of using low rate fluoroscopy to reduce an examiner's radiation dose during lumbar nerve root block

2018 ◽  
Vol 23 (5) ◽  
pp. 739-743
Author(s):  
Kentaro Yamane ◽  
Nobuo Kai ◽  
Tetsuro Mazaki ◽  
Tadashi Miyamoto ◽  
Tomohiro Matsushita
Keyword(s):  
Radiation Dose ◽  
Nerve Root ◽  
Nerve Root Block ◽  
Lumbar Nerve Root ◽  
Low Rate

Diagnostic Lumbar Nerve Root Block

1988 ◽  
Vol 1 (3) ◽  
pp. 232???235
Author(s):  
Bo J??nsson ◽  
Bj??rn Str??mqvist ◽  
M??rten Annertz ◽  
Stig Holt??s ◽  
G??ran Sund??n
Keyword(s):  
Nerve Root ◽  
Nerve Root Block ◽  
Lumbar Nerve Root

scholarly journals Ventricular Pneumocephalus with Meningitis after Lumbar Nerve Root Block

2013 ◽  
Vol 2013 ◽  
pp. 1-3 ◽  
Author(s):  
Shin Ahn ◽  
Young Sang Ko ◽  
Kyung Soo Lim
Keyword(s):  
Bacterial Meningitis ◽  
Nerve Root ◽  
Sudden Hearing Loss ◽  
Cranial Computed Tomography ◽  
High Dose ◽  
Impaired Hearing ◽  
Nerve Root Block ◽  
Left Lateral Ventricle ◽  
Frontal Horn ◽  
Lumbar Nerve Root

Lumbar nerve root block is a common modality used in the management of radiculopathy. Its complications are rare and usually minor. Despite its low morbidity, significant acute events can occur. Pneumocephalus is an accumulation of air in the intracranial space. It indicates a violation of the dura or the presence of infection. The object of this report is to describe the case of a patient with intraventricular pneumocephalus and bacterial meningitis after lumbar nerve root block. A 70-year-old female was brought into emergency department with severe headache and vomiting which developed during her sleep. She had received lumbar nerve block for her radiculopathy one day before her presentation. Cranial computed tomography scan revealed a few hypodense lesions in her left lateral ventricle frontal horn and basal cistern indicating ventricular pneumocephalus. Five hours later, she developed sudden hearing loss. Cerebrospinal fluid analysis showed bacterial meningitis, and she was treated with high dose steroid and antibiotics. However, her impaired hearing as a sequela from meningitis was persistent, and she is still in follow-up. Intracranial complications of lumbar nerve root block including meningitis and pneumocephalus can occur and should be considered as high-risk conditions that require prompt intervention.

Lumbar nerve root blocks using MRI – the effectiveness and safety of ultrasound/MRI fusion image guidance

2021 ◽  
Author(s):  
David John Wilson ◽  
Gina Allen ◽  
Stuart Bullock ◽  
Jon Denton
Keyword(s):  
Nerve Root ◽  
Fusion Imaging ◽  
Fluoroscopic Guidance ◽  
Imaging Guidance ◽  
Patient’S Satisfaction ◽  
Nerve Root Block ◽  
Lumbar Nerve Root ◽  
Significant Difference ◽  
Nerve Root Blocks ◽  
Clinical Records

Objective: To compare the outcome of nerve root injection guided by ultrasound/MRI fusion with radiofrequency needle tracking (eTRAX©) and the same procedure undertaken by fluoroscopic guidance. Methods: This is a retrospective audit of anonymised clinical records from before and after a change in the imaging technique used to perform nerve root blocks. We studied 181 consecutive patients who had undergone a nerve root block, the first 124 guided by fluoroscopic technique and the next 57 guided by ultrasound/MRI fusion with radiofrequency needle guidance. Using pain diaries, we reviewed the outcome scores at 24 h and 2 weeks. We recorded the use of analgesia, the patient’s satisfaction, complications and the duration of the procedures. Results: Completed pain diaries were returned by 61% in the fluoroscopy group and 67% in the fusion imaging group. The visual analogue pain score was reduced at 24 h by 3.29 [standard deviation (SD) 2.35] for the fluoroscopy group and by 3.69 (SD 2.58) in the fusion group (p 0.399). At two weeks the pain reduction was 3.27 (SD 2.57) for the fluoroscopic group and 4.21 (SD 2.95) for the fusion group (p 0.083). There was no statistically significant difference between the groups. The patient’s satisfaction scores were similar for both groups. The procedure by the two guidance methods took a similar time to perform. There were no serious complications in either group. One patient in the fusion-guided nerve root block group experienced paraesthesia in the nerve distribution for 2 h. Conclusion: Ultrasound/MRI fusion imaging with needle tracking is an effective alternative to fluoroscopic image-guided injection. Advances in knowledge: Fusion imaging guidance provides the same outcome as fluoroscopic guidance. Fusion imaging guidance avoids the need for ionising radiation.

scholarly journals CT-Guided Lumbar Nerve Root Injections: Are We Using the Correct Radiation Dose Settings?

2012 ◽  
Vol 33 (10) ◽  
pp. 1855-1859 ◽  
Author(s):  
J.S. Schauberger ◽  
P.G. Kranz ◽  
K.R. Choudhury ◽  
J.D. Eastwood ◽  
L. Gray ◽  
...  
Keyword(s):  
Radiation Dose ◽  
Nerve Root ◽  
Ct Guided ◽  
Lumbar Nerve Root

scholarly journals Radiation Dose and Procedure Time for 994 CT-guided Spine Pain Control Procedures

2017 ◽  
Vol 4 (20;4) ◽  
pp. E585-E591 ◽  
Author(s):  
Matthew S. Lazarus
Keyword(s):  
Radiation Dose ◽  
Nerve Root ◽  
Pain Control ◽  
Steroid Injection ◽  
Ct Guidance ◽  
Procedure Time ◽  
Nerve Root Block ◽  
Spine Pain ◽  
Control Procedures ◽  
Epidural Steroid

Background: Image guidance for spine pain control procedures, including epidural steroid injection, nerve root block, and facet block, can be performed with either computed tomography (CT) or conventional fluoroscopy. CT has the advantage of improved anatomic localization and use of air for contrast; however, there are concerns that CT leads to higher radiation dose and longer procedure time. Objective: To evaluate procedure time and radiation dose for multiple types of spine pain control procedures performed under CT guidance. Study Design: Retrospective evaluation. Setting: Department of radiology in single academic medical center. Methods: Institutional review board approval was obtained. We reviewed CT-guided spine procedures performed over a 12-month period from January 2012 to December 2012. Procedure type, procedure time, and dose-length product were recorded. Patient age and gender were recorded for each case; additionally, demographic and medical history data were obtained for a sub-group of patients. Results: Nine hundred ninety-four studies (performed in 699 patients) were reviewed, including 585 epidural steroid injections, 228 nerve root blocks, and 90 facet blocks. For all studies, procedure time averaged 7:34 ± 5:05, and dose-length product averaged 75 mGy·cm ± 61. Additional medical history (available for 483 patients) revealed high rate of obesity (body mass index [BMI] = 30 ± 6.8, with 76% of patients overweight [BMI > 25] and 42% obese [BMI > 30]), and frequent medical comorbidities (including hypertension [n = 179], diabetes [n = 101], renal failure [n = 30], and heart failure [n = 17]). Limitations: This study was performed retrospectively, and limited to a single institution. Conclusion: These findings add to the growing evidence that CT guidance is a safe and effective technique for epidural steroid injection. These results further demonstrate that other spine intervention procedures, including nerve root block and facet block, can also be performed under CT guidance with short procedure time and reasonable levels of radiation exposure. This approach can be effectively used in a patient population with a high rate of obesity and medical comorbidities. Key words: Epidural steroid injection, nerve root block, facet block, CT-guidance, spine intervention, radiation dose

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