Department of Radiology, Innstruck Medical University, 6020 Innsbruck, Austria.
AJNR Am J Neuroradiol. 2013 Feb;34(2):466-70. doi: 10.3174/ajnr.A3206. Epub 2012 Jul 19.
Injection therapies play a major role in the treatment of lower back pain and are to date performed mainly under CT- or fluoroscopic guidance. We conducted this study to evaluate the accuracy, time savings, radiation doses, and pain relief of US-guided pararadicular injections versus CT-controlled interventions in the lumbar spine in a prospective randomized clinical trial.
Forty adult patients were consecutively enrolled and assigned to a US or CT group. US-guided pararadicular injections were performed on a standard US device by using a broadband curved-array transducer (9-4 or 5-1 MHz). In the in-plane technique, the needle was advanced through the respective segmental intertransverse ligament. The needle tip position was verified by CT. The CT-guided approaches were performed under standardized procedures by using the CT-positioning laser function.
The accuracy of US-guided interventions was 90%. The mean time to final needle placement in the US group was 4.0 ± 1.8 minutes, and in the CT group, 7.6 ± 2.1 minutes. The mean radiation doses, including CT confirmation for study purposes only, were 20.3 ± 9.0 mGy cm for the US group and 42.6 ± 36.1 mGy cm for the CT group. Both groups showed the same significant pain relief (P < .05) without relevant "intermethodic" differences of pain relief (P > .05).
US-guided pararadicular injections show a therapeutic effect similar to that in the time-consuming, expensive, ionizing CT or fluoroscopically guided pararadicular injections and result in a significant reduction of procedure time expenditure and avoidance of radiation.
注射疗法在治疗下腰痛方面发挥着重要作用，迄今为止，这些疗法主要在 CT 或透视引导下进行。我们进行这项前瞻性随机临床试验，旨在评估超声引导下椎间孔外注射与 CT 控制介入治疗腰椎疾病的准确性、节省时间、辐射剂量和缓解疼痛的效果。
连续纳入 40 名成年患者，并将其分配至超声或 CT 组。在标准超声设备上使用宽带曲面探头（9-4MHz 或 5-1MHz）进行超声引导下椎间孔外注射。在平面内技术中，通过相应的节段椎间横突间韧带进针。使用 CT 定位激光功能验证针尖位置。CT 引导方法在标准化程序下进行。
超声引导干预的准确性为 90%。在超声组中，最终将针放置到位的平均时间为 4.0±1.8 分钟，在 CT 组中为 7.6±2.1 分钟。包括仅出于研究目的进行 CT 确认的平均辐射剂量，超声组为 20.3±9.0mGycm，CT 组为 42.6±36.1mGycm。两组均表现出相同的显著疼痛缓解（P<0.05），但缓解程度无显著差异（P>0.05）。
超声引导下椎间孔外注射与耗时、昂贵、电离的 CT 或透视引导下椎间孔外注射具有相似的治疗效果，可显著缩短手术时间，并避免辐射。
