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 Spread of Contrast During L4 and L5 Nerve Root Infiltration Under Fluoroscopic Guidance

2007 ◽  
Vol 3;10 (5;3) ◽  
pp. 461-466
Author(s):  
Dmitri Vassiliev
Keyword(s):  
Nerve Root ◽  
Water Soluble ◽  
Fluoroscopic Guidance ◽  
Lumbar Radiculopathy ◽  
Nerve Roots ◽  
Nerve Root Block ◽  
Significant Difference ◽  
Lumbar Segment ◽  
Nerve Root Blocks ◽  
Selective Nerve Root Block

Background: Lumbar selective nerve root blocks have been performed to establish the origin of lumbar radiculopathy in clinically difficult cases. The diagnostic ability of selective nerve root blocks remains controversial because of concern over potential spread of an injectate onto adjacent structures. Objective: To investigate the spread of different volumes of water-soluble contrast during L4 and L5 selective nerve root blocks. Design: Retrospective, observational case series. Methods: Analysis of medical records and X-ray images obtained during L4 and L5 selective nerve root blocks. Results: During L4 selective nerve root block 1 ml of contrast spread onto L5 nerve roots in 46.1% of subjects and during L5 nerve root block 1 ml of contrast spread onto S1 nerve root in 57.7%. There was statistically significant difference (p<0.0001) between spread of contrast onto the medially located nerve root in the same lumbar segment and nerve roots in the lumbar segment above. Conclusions: Injection of 1 ml of contrast under fluoroscopic guidance does not guarantee selective spread of the contrast around L4 or L5 nerve roots only. There is also spread toward the more medial nerve root in the same spinal segment during L4 and L5 nerve root infiltration. These findings suggest that it is possible to differentiate between L4 and L5 nerve root pathology using a sequential nerve root blocks under fluoroscopic guidance. Key words: Selective nerve root block, Lumbar radiculopathy, Fluoroscopic guidance

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 Imaging Guidance Improves the Results of Viscosupplementation with HANOX-M-XL in Patients with Ankle Osteoarthritis: Results of a Clinical Survey in 50 Patients Treated in Daily Practice

2016 ◽  
Vol 9 ◽  
pp. CMAMD.S40401 ◽  
Author(s):  
Marie Bossert ◽  
Daniel Boublil ◽  
Jean-Marc Parisaux ◽  
Ana-Maria Bozgan ◽  
Emmanuel Richelme ◽  
...  
Keyword(s):  
Success Rate ◽  
Safety Concern ◽  
Demographic Data ◽  
Daily Practice ◽  
Ankle Osteoarthritis ◽  
Level Of Evidence ◽  
Imaging Guidance ◽  
Patient’S Satisfaction ◽  
Significant Difference ◽  
Highly Correlated

Background The objective of this survey was to assess retrospectively the interest of performing viscosupplementation using imaging guidance in patients suffering from ankle osteoarthritis (OA). Patients and Methods This is a multicenter retrospective survey using a standardized questionnaire. Fifty patients suffering from ankle OA and treated, in daily clinical practice, with a single intra-articular injection of a novel viscosupplement made of a combination of a non-animal cross-linked hyaluronan and mannitol, HANOX M-XL, were included in the survey. The injection procedure (imaging or landmark guidance), demographic data, patient's self-evaluation of pain, satisfaction, treatment efficacy, and tolerability were collected. Predictive factors of both efficacy and patient's satisfaction were investigated. Results The percentages of patients very satisfied/satisfied and not really satisfied/dissatisfied with the treatment were 68% and 32%, respectively. Efficacy was rated as very good, good, moderate, and poor by 38%, 30%, 12%, and 20% of the cases, respectively. Efficacy was unrelated to gender and age and was highly correlated with pain score ( P < 0.0001). In satisfied patients, the decrease in consumption of analgesics/non-steroidal anti-inflammatory drugs was >75% in 64% of the cases. Efficacy was significantly different with regard to imaging guidance. There was a statistically significant difference in efficacy and satisfaction between landmark-guided and imaging-guided injections ( P = 0.02). The success rate was 2.3 times higher in the imaging-guided group than in the landmark-guided group. No significant difference was found between patients injected under fluoroscopy or ultrasound guidance, despite a trend favoring ultrasound ( P = 0.09). Tolerability was rated as very good/good in 47 patients, moderate in two, and poor in one and was unrelated to the type of guidance. Conclusion This preliminary study suggests that the use of imaging guidance significantly optimizes the success rate of ankle viscosupplementation. No safety concern was observed. LEVEL OF EVIDENCE III.

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.

scholarly journals The Efficacy and Persistence of Selective Nerve Root Block under Fluoroscopic Guidance for Cervical Radiculopathy

2012 ◽  
Vol 6 (4) ◽  
pp. 227 ◽  
Author(s):  
Jae-Yoon Chung ◽  
Ji-Hyeon Yim ◽  
Hyoung-Yeon Seo ◽  
Sung-Kyu Kim ◽  
Kyu-Jin Cho
Keyword(s):  
Nerve Root ◽  
Cervical Radiculopathy ◽  
Fluoroscopic Guidance ◽  
Nerve Root Block ◽  
Selective Nerve Root Block

Complications of Cervical Selective Nerve Root Blocks Performed with Fluoroscopic Guidance

2007 ◽  
Vol 188 (5) ◽  
pp. 1218-1221 ◽  
Author(s):  
Marc A. Wallace ◽  
Melanie B. Fukui ◽  
Robert L. Williams ◽  
Andrew Ku ◽  
Parviz Baghai
Keyword(s):  
Nerve Root ◽  
Fluoroscopic Guidance ◽  
Nerve Root Blocks

scholarly journals Computed tomography versus fluoroscopic guided-sacroiliac joint injection: a prospective comparative study

2021 ◽  
Vol 12 (1) ◽  
Author(s):  
Ahmed A. A. Bessar ◽  
Mohamed M. Arnaout ◽  
Mohammad Abd Alkhalik Basha ◽  
Shady E. Shaker ◽  
Ashraf E. Elsayed ◽  
...  
Keyword(s):  
Pain Relief ◽  
Sacroiliac Joint ◽  
Fluoroscopic Guidance ◽  
Ct Guided ◽  
Patient’S Satisfaction ◽  
Post Procedure ◽  
Significant Difference ◽  
Clinically Significant ◽  
A Prospective Study

Abstract Background There are limited data discussing long-term pain relief and comparability of different image-guided sacroiliac joint (SIJ) injection. This study compared CT and fluoroscopic-guided SIJ injections regarding statistically and clinically significant differences in numeric pain reduction, radiation doses, and patient’s satisfaction. Methods A prospective study conducted on 52 patients who met specific inclusion criteria of SIJ pain. A mixture of 1 ml of 40 mg methylprednisolone acetate diluted in 2 ml of lidocaine 2% was injected under either CT or fluoroscopic guidance. Numeric rating score (NRS) and Oswestry disability index (ODI) were assessed and recorded for each patient before procedure and one-week, and one-, three-, six-, and 12-months after procedure. The results were compared between both groups. Results Analysis of NRS one-month post-procedure showed a significant decrease from baseline in both groups: 12.5% in CT group (p = 0.002) and 9.5% in fluoroscopic group (p = 0.006). No significant difference in NRS between two groups at one- and three-months post-procedure (p = 0.11 and 0.1, respectively). There was a significant difference in NRS between two groups at six- and 12-months post-procedure (p = 0.001 and < 0.0001, respectively). Comparison of ODI at six-month post-procedure revealed that both groups had a statistically significant improvement (p < 0.0001). There was a significant difference in ODI between two groups at six-months post-procedure (p = 0.01). Conclusions CT-guided SIJ injection compares favorably with fluoroscopic guidance and offers statistically and clinically significant long-term pain relief. The use of dose reduction protocol in CT is important for decreasing the radiation dose.

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