Ultrasound-guided lumbar transforaminal injections: feasibility and validation study (spine 2012 20;37(9):808-812)

Spine 2012 Apr 20;37(9):808-12.

Title:

Ultrasound-guided lumbar transforaminal injections: feasibility and validation study

 

Authors

Gofeld M

Bristow SJ

Chiu SC

McQueen CK

Bollag L.

Study Design

Preclinical feasibility study

Objective

Evaluation and validation of ultrasound-guided lumbar transforaminal injections

Summary of Background Data

1. Lumbar transforaminal injections are typically administered under fluoroscopy or computed tomography.

2. Although radiological guidance provides anatomical precision and accuracy, it is associated with radiation exposure and cannot be performed during outpatient visits or at bedside.

3. 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

1. 46 procedures were performed in 50 planned injections.

2. L5/S1 foraminal access was impossible in 4 cases (8%).

3. Fluoroscopy confirmed the correct foraminal placement in all 46 injections (100%).

4. Contrast-spread pattern

>>> Intraforaminal in 42 cases (91.3%)

>>> Extraforaminal (nerve root) in 4 cases (8.7%).

5. As detecting intraforaminal pattern on anteroposterior image, lateral fluoroscopy demonstrated ventral epidural flow in all occasions.

6. In 3 cases, intravascular injection was detected (6.5%).

Conclusion

Ultrasound-guided lumbar transforaminal injections are accurate and feasible in the preclinical setting.

Key points

1. A modified in –plane technique aiming vertebral body as a sonographic landmark prevents further advancement into the neuraxial compartment.

2. Advantages

>>> Bedside procedural setting

>>> Protect patients and personnel from radiation exposure

>>> Provide reliable setup in localizing foramina

3. Water-soluble steroids should be used when practicing this technique.

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