Department of Orthopedic Surgery, Akita University Graduate School of Medicine, 1-1-1 Hondo, Akita, Akita, 010-8543, Japan.
Scientific Research WorkS Peer Support Group (SRWS-PSG), Osaka, Japan.
Eur Spine J. 2023 Dec;32(12):4101-4110. doi: 10.1007/s00586-023-07968-y. Epub 2023 Oct 6.
Spinal nerve injections have traditionally been performed under fluoroscopic (FL) and computed tomography (CT) guidance. Recently, ultrasound (US)-guided procedures have provided an alternative guidance approach that does not expose the patient and operator to radiation. The aim of this study was to compare the efficacy and safety of US-guided spinal nerve injections compared with FL- or CT-guided spinal nerve injections.
MEDLINE, Cochrane Library, EMBASE, international clinical trials registry platform (ICTRP) and ClinicalTrials.gov database searches for inclusion until February 2023 were independently performed by two authors using predefined criteria. Randomized controlled trials (RCTs) were included. Primary outcomes were change in pain score (numeric rating scale or visual analogue scale) and major adverse events. Secondary outcomes were procedure time, change in functional disability score and minor adverse events. Meta-analysis was performed using random-effect model. We evaluated the certainty of evidence based on the Grading of Recommendations, Assessment and Development (GRADE) approach.
Eight RCTs involving 962 patients were included. There might be little to no difference in the mean score of the pain change between the US-guided methods and the FL- or CT-guided injections (standard mean difference -0.06; 95% confidence interval [CI] -0.26 to 0.15). US guidance probably reduced major adverse events (0.7% [3/433] and 6.5% [28/433], respectively), reduced procedure time (mean difference -4.19 min; 95% CI -5.09 to -3.30), and probably reduced minor adverse events (2.1% [9/433] and 4.2% [18/433], respectively) compared with FL or CT guidance. There was probably little to no difference in the change in functional disability score with either method.
US-guided spinal nerve injections remained effective and reduced adverse events compared with conventional FL- or CT-guided spinal nerve injections. Further RCTs are required to verify our results.
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传统上，脊柱神经注射是在透视 (FL) 和计算机断层扫描 (CT) 引导下进行的。最近，超声 (US) 引导的程序提供了一种替代的引导方法，不会使患者和操作者暴露在辐射下。本研究的目的是比较 US 引导的脊柱神经注射与 FL 或 CT 引导的脊柱神经注射的疗效和安全性。
两位作者独立使用预定义的标准，对截至 2023 年 2 月的 MEDLINE、Cochrane 图书馆、EMBASE、国际临床试验注册平台 (ICTRP) 和 ClinicalTrials.gov 数据库进行了检索。纳入随机对照试验 (RCT)。主要结局是疼痛评分的变化（数字评分量表或视觉模拟量表）和主要不良事件。次要结局是手术时间、功能障碍评分的变化和次要不良事件。使用随机效应模型进行荟萃分析。我们根据推荐评估、制定和评价（GRADE）方法评估证据的确定性。
纳入了 8 项涉及 962 名患者的 RCT。US 引导方法与 FL 或 CT 引导注射之间的疼痛变化平均评分可能没有差异（标准均数差-0.06；95%置信区间 [CI] -0.26 至 0.15）。US 引导可能降低主要不良事件（分别为 0.7% [3/433] 和 6.5% [28/433]）、缩短手术时间（平均差-4.19 分钟；95%CI -5.09 至 -3.30），并可能降低次要不良事件（分别为 2.1% [9/433] 和 4.2% [18/433]）与 FL 或 CT 引导相比。两种方法在功能障碍评分的变化上可能没有差异。
与传统的 FL 或 CT 引导的脊柱神经注射相比，US 引导的脊柱神经注射仍然有效且减少了不良事件。需要进一步的 RCT 来验证我们的结果。
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