title: Ultrasound-guided versus computed tomography-controlled periradicular injections in the middle and lower cervical spine: a prospective randomized clinical trial.
abstract: OBJECTIVE
  We conducted this study to evaluate accuracy, time saving, radiation doses, safety, and pain relief of ultrasound (US)-guided periradicular injections versus computed tomography (CT)-controlled interventions in the cervical spine in a prospective randomized clinical trial.
  
  
  METHODS
  Forty adult patients were consecutively enrolled and randomly assigned to either a US or a CT group. US-guided periradicular injections were performed on a standard ultrasound device using a broadband linear array transducer. By basically following the osseous landmarks for level definition in "in-plane techniques", a spinal needle was advanced as near as possible to the intended, US-depicted nerve root. The respective needle tip positioning was then verified by CT. The control group underwent CT-guided injections, which were performed under standardized procedures using the CT-positioning laser function.
  
  
  RESULTS
  The accuracy of US-guided interventions was 100%. The mean time to final needle placement in the US group was 02:21 ± 01:43 min:s versus 10:33 ± 02:30 min:s in the CT group. The mean dose-length product radiation dose, including CT confirmation for study purposes only, was 25.1 ± 16.8 mGy cm for the US group and 132.5 ± 78.4 mGy cm for the CT group. Both groups showed the same significant visual analog scale decay (p < 0.05) without "inter-methodic" differences of pain relief (p > 0.05).
  
  
  CONCLUSIONS
  US-guided periradicular injections are accurate, result in a significant reduction of procedure expenditure under the avoidance of radiation and show the same therapeutic effect as CT-guided periradicular injections.
authors.affiliation: Department of Neurosurgery, Innsbruck Medical University, Anichstrasse 35, 6020, Innsbruck, Austria, jochen.obernauer@uki.at.
authors.forename: Jochen
authors.initials: J
authors.lastname: Obernauer
authors.forename: Klaus
authors.initials: K
authors.lastname: Galiano
authors.forename: Hannes
authors.initials: H
authors.lastname: Gruber
authors.forename: Reto
authors.initials: R
authors.lastname: Bale
authors.forename: Alois Albert
authors.initials: AA
authors.lastname: Obwegeser
authors.forename: Reinhold
authors.initials: R
authors.lastname: Schatzer
authors.forename: Alexander
authors.initials: A
authors.lastname: Loizides
mesh_terms: D000328:Adult; D001623:Betamethasone / Q000008:administration & dosage; D002574:Cervical Vertebrae; D005240:Feasibility Studies; D005260:Female; D005938:Glucocorticoids / Q000008:administration & dosage; D006801:Humans; D007278:Injections, Spinal; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D011843:Radiculopathy / Q000000981:diagnostic imaging / Q000628:therapy*; D014057:Tomography, X-Ray Computed; D018084:Ultrasonography, Interventional
chemical_list: D005938:Glucocorticoids; D001623:Betamethasone