Department of Physical Medicine and Rehabilitation, Mayo Clinic, 200 1st St SW, Rochester, MN 55905.
Department of Pain Medicine, Mayo Clinic, Rochester, MN.
PM R. 2018 Apr;10(4):382-390. doi: 10.1016/j.pmrj.2017.09.008. Epub 2017 Sep 21.
Ultrasound is rarely used for guiding lumbosacral epidural steroid injections due to its technical limitations. For example, sonographic imaging lacks the ability to confirm epidural spread and identify vascular uptake. The perceived risk that these limitations pose to human subjects has precluded any large scale clinical trials to date.
To compare the accuracy of ultrasound versus fluoroscopic guidance for first sacral transforaminal epidural injections.
Cadaveric comparative study using dichotomous outcomes.
A fluoroscopy suite and anatomic laboratory at an academic medical center.
Four unembalmed adult human cadavers with no history of spinal surgery.
Eight sites were injected twice by one interventionalist, using fluoroscopic and ultrasound guidance. In the fluoroscopy arm, contrast spread was assessed using computed tomography. In the ultrasound arm, latex spread was assessed using gross anatomic dissection. Any visible evidence of epidural spread constituted a positive result.
Comparison of the success of obtaining epidural contrast flow was the primary outcome measure. Secondary outcome measures included average duration, rate of intravascular uptake, and quantity of intravascular uptake.
All injections performed in both the ultrasound arm and the fluoroscopy arm had positive epidural spread. The average duration was 3.03 minutes with fluoroscopy and 4.76 minutes with ultrasound. The rate of intravascular uptake was 37.5% with fluoroscopy and 50% with ultrasound. Within the ultrasound arm, greater intravascular spread and duration variability were recorded.
Although ultrasonography can provide reliable image guidance for cannulating the first sacral foramen in cadavers, it would have limited clinical utility due to its inability to visualize relevant neurovascular structures deep to the osseus roof and exclude intravascular uptake.
IV.
由于技术限制，超声很少用于引导腰骶部硬膜外类固醇注射。例如，超声成像缺乏确认硬膜外扩散和识别血管摄取的能力。这些限制对人体受试者构成的潜在风险使得迄今为止任何大型临床试验都无法进行。
比较超声与透视引导初次骶骨椎间孔硬膜外注射的准确性。
使用二项结果的尸体比较研究。
学术医疗中心的透视套房和解剖实验室。
四个无防腐的成年人体尸体，无脊柱手术史。
一名介入放射科医生用透视和超声引导对 8 个部位进行了两次注射。在透视组中，使用计算机断层扫描评估对比扩散。在超声组中，使用大体解剖学剖检评估乳胶扩散。任何可见的硬膜外扩散证据均构成阳性结果。
获得硬膜外对比流动的成功率是主要观察指标。次要观察指标包括平均持续时间、血管内摄取率和血管内摄取量。
在超声组和透视组的所有注射中，均有阳性的硬膜外扩散。透视组的平均持续时间为 3.03 分钟，超声组为 4.76 分钟。透视组的血管内摄取率为 37.5%，超声组为 50%。在超声组中，记录到更大的血管内扩散和持续时间变异性。
尽管超声检查可以为尸体穿刺第一骶骨孔提供可靠的图像引导，但由于其无法可视化骨顶深处的相关神经血管结构并排除血管内摄取，因此其临床应用有限。
IV。
