Ultrasound-Guided Lumbar Transforaminal Injections Feasibility and Validation Study
Ultrasound-Guided Lumbar Transforaminal Injections Feasibility and Validation Study
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DOI：
10.1097/brs.0b013e3182340096
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发表时间：
2012-04-20
期刊：
影响因子：
3
通讯作者：
Bollag, Laurent
中科院分区：
文献类型：
--
作者：
Gofeld, Michael;Bristow, Sandee J.;Bollag, Laurent
研究设计。临床前可行性研究。超声引导下腰椎经椎间孔注射的评价与验证。背景资料摘要。腰椎经椎间孔注射是脊髓根性疼痛介入治疗的常规方法。通常，这些注射是在透视或计算机断层扫描下进行的。尽管放射指导提供了解剖学的精确性和准确性，但它与辐射暴露有关，不能在门诊或床边进行。超声引导技术以前已经描述过；然而，方法的普遍性仍然未知，并且从未在多个脊柱水平上进行常规透视检查的验证。我们讨论了超声引导下腰椎经椎间孔注射的程序准确性，并提出了解剖学上合理的方法。进行透视验证。在计划的50次注射中，有46次进行了注射。4例（8%）无法进入L5/S1椎间孔。在所有46次注射中，透视检查证实了正确的椎间孔位置（100%）。对比扩散模式为椎间孔内42例（91.3%），椎间孔外（神经根）4例（8.7%）。当在正位图像上检测到椎间孔内模式时，侧位透视显示在所有情况下都有腹侧硬膜外流。血管内注射检出3例（6.5%）。超声引导下经椎间孔腰椎注射在临床前是准确和可行的。
Study Design. Preclinical feasibility study.Objective. Evaluation and validation of ultrasound-guided lumbar transforaminal injections.Summary of Background Data. Lumbar transforaminal injections are routinely implemented in the interventional management of spinal radicular pain. Typically, these injections are administered under fluoroscopy or computed tomography. Although radiological guidance provides anatomical precision and accuracy, it is associated with radiation exposure and cannot be performed during outpatient visits or at bedside. Ultrasound-guided techniques have been previously described; however, the methodological generalizability remained unknown and validation against routine fluoroscopy has never been conducted on multiple spinal levels.Methods. We addressed the procedural accuracy of ultrasound-guided lumbar transforaminal injections and proposed anatomically sound approach. Fluoroscopic validation was performed.Results. Of the 50 planned injections, 46 procedures were performed. L5/S1 foraminal access was impossible in 4 cases (8%). Fluoroscopy confirmed the correct foraminal placement in all 46 injections (100%). The contrast-spread pattern was intraforaminal in 42 cases (91.3%) and extraforaminal (nerve root) in 4 cases (8.7%). When intraforaminal pattern was detected on anteroposterior image, lateral fluoroscopy demonstrated ventral epidural flow in all occasions. In 3 cases, intravascular injection was detected (6.5%).Conclusion. Ultrasound-guided lumbar transforaminal injections are accurate and feasible in the preclinical setting.