University of Heidelberg, Medical Faculty Mannheim, Department of Neuroradiology, Theodor-Kutzer-Ufer 1-3, Mannheim, Germany.
PLoS One. 2013 Jul 19;8(7):e69311. doi: 10.1371/journal.pone.0069311. Print 2013.
Cervical selective nerve root block (CSNRB) is a well-established, minimally invasive procedure to treat radicular cervical pain. However, the procedure is technically challenging and might lead to major complications. The objective of this study was to evaluate the feasibility of a three-dimensional puncture planning and two-dimensional laser-guidance system for CSNRB in an ex-vivo model.
Dyna-CT of the cervical spine of an ex-vivo lamb model was performed with the Artis Zee® Ceiling (Siemens Medical Solutions, Erlangen, Germany) to acquire multiplanar reconstruction images. 15 cervical nerve root punctures were planned and conducted with the syngo iGuide® laser-guidance system. Needle tip location and contrast dye distribution were analyzed by two independent investigators. Procedural, planning, and fluoroscopic time, tract length, and dose area product (DAP) were acquired for each puncture.
All 15 punctures were rated as successful with 12 punctures on the first attempt. Total procedural time was approximately 5 minutes. Mean planning time for the puncture was 2.03 (±0.39) min. Mean puncture time was 2.16 (±0.32) min, while mean fluoroscopy time was 0.17 (±0.06) min. Mean tract length was 2.68 (±0.23) cm. Mean total DAP was 397.45 (±15.63) µGy m(2).
CSNRB performed with Dyna-CT and the tested laser guidance system is feasible. 3D pre-puncture planning is easy and fast and the laser-guiding system ensures very accurate and intuitive puncture control.
颈椎选择性神经根阻滞（CSNRB）是一种成熟的微创治疗神经根性颈椎痛的方法。然而，该操作技术要求较高，可能导致严重并发症。本研究旨在评估三维穿刺规划和二维激光引导系统在离体模型中用于 CSNRB 的可行性。
使用 Artis Zee® Ceiling（西门子医疗解决方案，德国埃朗根）对离体羊颈椎进行 Dyna-CT 检查，以获取多平面重建图像。使用 syngo iGuide®激光引导系统对 15 例颈椎神经根穿刺进行了规划和操作。由两名独立观察者分析针尖位置和对比染料分布。获取每例穿刺的操作、规划和透视时间、轨迹长度和剂量面积乘积（DAP）。
所有 15 例穿刺均被评为成功，其中 12 例为首次尝试。总操作时间约为 5 分钟。穿刺的平均规划时间为 2.03（±0.39）分钟。平均穿刺时间为 2.16（±0.32）分钟，而平均透视时间为 0.17（±0.06）分钟。平均轨迹长度为 2.68（±0.23）厘米。总 DAP 平均值为 397.45（±15.63）µGy m²。
使用 Dyna-CT 和测试的激光引导系统进行 CSNRB 是可行的。3D 术前规划简单快捷，激光引导系统可确保非常准确和直观的穿刺控制。
