Ultrasound versus fluoroscopic-guided epidural steroid injections in patients with degenerative spinal diseases: a randomised study.
BACKGROUND
Epidural steroid injections are routinely performed under fluoroscopic guidance, but could also be performed using preprocedure ultrasound spine examination.


OBJECTIVE
To compare ultrasound-assisted and fluoroscopy-controlled epidural steroid injections with regard to technical feasibility (accuracy, average procedure time) and outcome (pain relief and degree of disability score).


METHODS
A randomised study.


METHODS
University hospital between January 2010 and September 2012.


METHODS
One hundred and twelve patients with axial chronic lower back and extremity pain diagnosed with degenerative diseases of the spine, receiving three lumbar interlaminar epidural steroid injections, were randomly assigned between two groups.


METHODS
In the fluoroscopic group, injections were performed under fluoroscopic guidance, and in the ultrasound group, ultrasound scanning of the lumbar spine was performed before the injection to determine the puncture site, depth of the epidural space and needle trajectory.


METHODS
Procedure time, numbers of needle insertion attempts and needle passes, visual analogue scale for pain and Oswestry disability index at 1 and 3 months posttreatment.


RESULTS
There was no significant difference between the two groups in mean procedure time, number of needle insertion attempts or needle passes. The mean pain intensity and degree of disability scores before the procedure, and at 1 and 3 months postprocedure, were similar in the two groups. Neither group had serious complications.


CONCLUSIONS
We have demonstrated the feasibility of ultrasound-assisted epidural steroid injections.
From the Department of Anaesthesiology (IE, IV) and Department of Neurology and Neurosurgery (IL) of Stradins University Hospital, Riga, Latvia, and the Department of Anesthesiology, Orthopedic University Hospital Balgrist, Zürich, Switzerland (AB).
Irina
I
Evansa
Inara
I
Logina
Indulis
I
Vanags
Alain
A
Borgeat
D000368:Aged; D000369:Aged, 80 and over; D059350:Chronic Pain / Q000175:diagnosis / Q000188:drug therapy* / Q000503:physiopathology; D004185:Disability Evaluation; D005240:Feasibility Studies; D005260:Female; D005471:Fluoroscopy; D006785:Hospitals, University; D006801:Humans; D007268:Injections, Epidural; D007844:Latvia; D017116:Low Back Pain / Q000175:diagnosis / Q000188:drug therapy* / Q000503:physiopathology; D008159:Lumbar Vertebrae; D008297:Male; D008875:Middle Aged; D010147:Pain Measurement; D011446:Prospective Studies; D011677:Punctures; D015641:Radiography, Interventional; D013122:Spinal Diseases / Q000175:diagnosis / Q000188:drug therapy* / Q000503:physiopathology; D013256:Steroids / Q000008:administration & dosage*; D013997:Time Factors; D016896:Treatment Outcome; D018084:Ultrasonography, Interventional
D013256:Steroids