Department of Medical Science, University of Ulsan College of Medicine, Seoul, Korea.
Skeletal Radiol. 2013 Jan;42(1):69-78. doi: 10.1007/s00256-012-1434-1. Epub 2012 May 20.
To compare the short-term effects and advantages of ultrasound-guided selective nerve root block with fluoroscopy-guided transforaminal epidural block for radicular pain in the lower cervical spine through assessment of pain relief, functional improvement, and safety.
A total of 120 patients with radicular pain from cervical spinal stenosis or cervical herniated disc were enrolled. All procedures were performed using a fluoroscopy or ultrasound apparatus. The subjects were randomly assigned to either the fluoroscopy (FL) or ultrasound (US) group. The complication frequencies during the procedures, treatment effects, and functional improvement of the nerve root block were compared at 2 and 12 weeks after the procedures.
Verbal Numeric Pain Scale (VNS) improved 2 weeks and 12 weeks after the injections in both groups. Statistical differences were not observed in VNS, Neck Disability Index (NDI), and effectiveness between the groups. In 21 patients at US, vessels were identified at the anterior aspect of the foramen. Eleven patients had a critical vessel at the posterior aspect of the foramen and five patients had on artery continue medially into the foramen, forming, or joining a segmental feeder artery. In both cases, the vessels might well have been in the pathway of the needle correctly positioned under fluoroscopic guidance. Five cases of intravascular injections were observed only in FL without significant difference between the groups.
The US-guided method may facilitate identifying critical vessels at unexpected locations relative to the intervertebral foramen and avoiding injury to such vessels, which is the leading cause of the reported complications from cervical transforaminal injections. On treatment effect, using either method of epidural injections to deliver steroids for cervical radicular pain, secondary to herniated intervertebral disc or foraminal stenosis, significant improvements in function and pain relief were observed in both groups after the intervention. However, significant difference was not observed between the groups. Therefore, the ultrasound-guided method was shown to be as effective as the fluoroscopy-guided method in pain relief and functional improvement, in addition to the absence of radiation and avoiding vessel injury at real-time imaging.
通过评估疼痛缓解、功能改善和安全性，比较超声引导下选择性神经根阻滞与透视引导下经椎间孔硬膜外阻滞治疗下颈椎神经根痛的短期效果和优势。
共纳入 120 例颈椎管狭窄或颈椎间盘突出症引起神经根痛的患者。所有操作均在透视或超声设备下进行。将患者随机分为透视组（FL）和超声组（US）。比较两组患者术中并发症发生率、治疗效果及神经阻滞功能改善情况。
两组患者注射后 2 周和 12 周时言语疼痛评分（VNS）均有所改善。两组间 VNS、颈部残疾指数（NDI）和疗效无统计学差异。在超声组的 21 例患者中，在前孔的前方发现血管。11 例患者在后孔的后方有一个临界血管，5 例患者有一条动脉继续向内侧进入孔内，形成或加入一个节段性供血动脉。在这两种情况下，血管可能都在正确定位的针的路径上，这是在透视引导下进行的。仅在 FL 组观察到 5 例血管内注射，两组间无显著差异。
超声引导法可帮助识别椎间孔以外的重要血管，避免损伤血管，这是颈椎经椎间孔注射报道并发症的主要原因。在治疗效果方面，两组患者均采用硬膜外注射类固醇治疗椎间盘突出或椎间孔狭窄引起的颈椎神经根痛，干预后功能和疼痛缓解均显著改善，但两组间无显著差异。因此，超声引导法在缓解疼痛和改善功能方面与透视引导法同样有效，而且不存在辐射，可实时成像避免血管损伤。
