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Ultrasound versus fluoroscopic-guided epidural steroid injections in patients with degenerative spinal diseases: a
Irina Evansa1, Inara Logina, Indulis Vanags
1From 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).
Background:
Epidural steroid injections are routinely performed under fluoroscopic guidance, but could also be performed using preprocedure ultrasound spine examination.
Objectives:
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).
Design:
A randomised study.
Setting:
University hospital between January 2010 and September 2012.
Patients:
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.
Intervention:
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.
Main Outcome Measures:
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.
Conclusion:
We have demonstrated the feasibility of ultrasound-assisted epidural steroid injections.
