Ann Rehabil Med.  2013 Oct;37(5):658-667. 10.5535/arm.2013.37.5.658.

Treatment Effects of Ultrasound Guide Selective Nerve Root Block for Lower Cervical Radicular Pain: A Retrospective Study of 1-Year Follow-up

• Park Y
• Ahn JK
• Sohn Y
• Jee H
• Lee JH
• Kim J
• Park KD

• KMID: 2266583
• DOI: http://doi.org/10.5535/arm.2013.37.5.658

Abstract

OBJECTIVE
To compare the long-term effects and advantages of ultrasound (US)-guided selective cervical nerve root block with fluoroscopy (FL)-guided transforaminal block.
METHODS
From March 2009 to November 2012, 162 patients received steroid injections for lower cervical radicular pain. A total of 114 patients fulfilled the inclusion criteria. All procedures were performed by using US or FL. We compared the intravascular injections during the procedure with the effects and functional scales at 3, 6, and 12 months after the procedure between the two groups. Successful treatments occurred when patients obtained significant pain reliefs (as measured by >50% improvements in the verbal numerical scale [VNS] score and >40% improvements in the neck disability index [NDI] score) and reported a patient satisfaction score of 3 or 4 points at 12 months after the injection. Image analysis of intravascular injection and chart review were performed. Logistic regression was performed to reveal the correlations between successful treatments and variables (patient's age, gender, duration of the disease, cause, injection method, and radiologic finding).
RESULTS
The VNS and NDI improved 3 months after the injection and continued to improve until 12 months for both groups. But there were no statistical differences in changes of VNS, NDI, and effectiveness between these two groups. The proportion of patients with successful treatment is illustrated as 62.5% in US-guided group and 58% in FL-guided group at 12 months. There were no significant differences between the groups or during follow-up periods. Three cases of the intravascular injections were done in FL-guided group.
CONCLUSION
The US-guided selective cervical nerve root blocks are facilitated by identifying critical vessels at unexpected locations relative to the foramen and to protect injury to such vessels, which is the leading cause of reported complications from FL-guided transforaminal blocks. On treatment effect, significant long-term improvements in functions and pain reliefs were observed in both groups after the intervention. However, significant differences were not observed between the groups. Therefore, the US-guided selective cervical nerve root block was shown to be as effective as the FL-guided transforaminal block in pain reliefs and functional improvements, in addition to the absence of radiation and protection vessel injury at real-time imaging.

Keyword

Ultrasonography; Fluoroscopy; Cervical radiculopathy; Nerve block

MeSH Terms

Fluoroscopy
Follow-Up Studies*
Humans
Logistic Models
Neck
Nerve Block
Patient Satisfaction
Radiculopathy
Retrospective Studies*
Ultrasonography*
Weights and Measures

Figure

• 

  Fig. 1 (A) Ultrasound-guided selective nerve root block (target nerve root C6). (B) This figure shows axial transverse ultrasound image of the C7 transverse process which has only 1 posterior tubercle. (C) Power Doppler image shows radicular arterial blood flows (arrowhead) of the C6 nerve root. (D) Needle (arrows) is placed on the dorsal surface of the C6 nerve root. (E) The targeted C6 nerve root is outlined by 1-2 mL contrast media (arrow). Contrast media spread to intraforaminal lesion (arrowhead). AT, anterior tubercle; PT, posterior tubercle.

• 

  Fig. 2 Anteroposterior view for C6 ultrasound-guided selective C6 nerve root block. (A) Contrast spread to intraforaminal epidural space. (B) Contrast spread to only distal nerve root.

• 

  Fig. 3 Illustration of significant pain reliefs (≥50% reduction in verbal numerical scale from baseline) and functional improvements (≥40% reduction in neck disability index from baseline). US, ultrasound; FL, fluoroscopy.

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