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Kweon Y, Jeong G, Kim S, Yang C, Cho E, Leem J. A Scoping Review of Clinical Studies on Procedures of Ultrasound-Guided Injection to Ensure Hygiene and Safety. Healthcare (Basel) 2025; 13:1165. [PMID: 40428001 PMCID: PMC12110851 DOI: 10.3390/healthcare13101165] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2025] [Revised: 05/09/2025] [Accepted: 05/13/2025] [Indexed: 05/29/2025] Open
Abstract
Background: Ultrasound guidance is widely used to enhance injection accuracy and safety. However, ultrasound-guided procedures require complex manipulation of both probe and needle. This simultaneous manipulation while maintaining sterility necessitates specific infection prevention protocols. This scoping review aimed to systematically investigate hygiene and safety procedures reported in clinical studies of ultrasound-guided injections. Methods: Following the Joanna Briggs Institute guideline, we conducted a systematic search of four databases (two English and two Korean) from inception to November 2023. Studies describing ultrasound-guided injection procedures with skin disinfection protocols were included. The extracted procedures were categorized and analyzed according to their timing (before, during, and after injection) and purpose. Results: Among 1728 studies identified, 86 met inclusion criteria. Notable variations were found in infection prevention practices, with only 5.81% reporting probe disinfection procedures and 27.91% documenting sterile probe cover use. Skin disinfection methods also varied, with iodophors (20.93%) and alcohol-based solutions (11.63%) being most common. Of studies describing ultrasound coupling agent procedures (26.74%), less than 20% specifically mentioned using sterile transmission agents. Documentation of temporal aspects of infection prevention was limited, with most studies not addressing precise timing of disinfection procedures or post-procedure probe reprocessing protocols. Conclusions: Our findings reveal considerable variation in infection prevention practices during ultrasound-guided injections and highlight gaps in documentation of hygiene protocols. These findings suggest the need for standardized, evidence-based protocols tailored to different anatomical sites and types of injections. Further research through expert consensus and real-world implementation is needed to develop and validate comprehensive guidelines for clinical practice.
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Affiliation(s)
- Yujin Kweon
- College of Korean Medicine, Wonkwang University, Iksan 54538, Republic of Korea;
| | - Goeun Jeong
- Easebody Korean Medical Clinic, Gwangju 61931, Republic of Korea;
| | - Sungha Kim
- KM Science Research Division, Korea Institute of Oriental Medicine, Daejeon 34054, Republic of Korea; (S.K.); (C.Y.)
| | - Changsop Yang
- KM Science Research Division, Korea Institute of Oriental Medicine, Daejeon 34054, Republic of Korea; (S.K.); (C.Y.)
| | - Eunbyul Cho
- KM Science Research Division, Korea Institute of Oriental Medicine, Daejeon 34054, Republic of Korea; (S.K.); (C.Y.)
- Department of Diagnostics, College of Korean Medicine, Wonkwang University, Iksan 54538, Republic of Korea
- Research Center of Traditional Korean Medicine, College of Korean Medicine, Wonkwang University, Iksan 54538, Republic of Korea
| | - Jungtae Leem
- Department of Diagnostics, College of Korean Medicine, Wonkwang University, Iksan 54538, Republic of Korea
- Research Center of Traditional Korean Medicine, College of Korean Medicine, Wonkwang University, Iksan 54538, Republic of Korea
- Department of Il-won Integrated Medicine, Wonkwang University Korean Medicine Hospital, Iksan 54538, Republic of Korea
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Vydyanathan A, Agrawal P, Donia K, Wahezi SE, Koushik SS, Slinchenkova K, Gritsenko K, Shaparin N. Feasibility of Ultrasound-Guided Lumbar Transforaminal Epidural Steroid Injections for Management of Lumbar Radicular Back Pain. J Pain Res 2025; 18:759-767. [PMID: 39991518 PMCID: PMC11844432 DOI: 10.2147/jpr.s499091] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2024] [Accepted: 02/10/2025] [Indexed: 02/25/2025] Open
Abstract
Background Whereas traditional image guidance for placement of transforaminal epidural steroid injections (TFESI) has been fluoroscopy, it has disadvantages including inability to identify soft tissue, radiation exposure, and contrast administration need. Several studies found that ultrasonography is reliable in localizing lumbar nerve root. Few have investigated the feasibility of performing ultrasound guided TFESI in the lumbar spine. This study seeks to aid in filling this gap. Methods Patients meeting inclusion criteria (BMI < 25) and exclusion criteria (no spinal deformity or previous lumbar surgery) were enrolled. Ultrasound visualization of nerve root and proximate placement of needle tip guided needle placement. Vascular signals were monitored. The contrast injection was done under real-time ultrasound visualization. Final needle placement with transforaminal epidural spread was assessed for accuracy by contrast fluoroscopy. Complications were assessed. Results Thirty ultrasound guided lumbar TFESI were performed. Visualization at the L2, L3, and L4 levels was successful. At the L5 level, needle tip was placed in proximity to the nerve root, but the final needle tip position for transforaminal placement and injection was not visualized; fluoroscopic guidance was used instead. There was no evidence of intravascular injection. No complications were noted. Conclusion Ultrasonography shows feasibility as an imaging modality in localizing lumbar intervertebral foramina at higher lumbar levels in patients with normal BMI and no spinal deformities. However, ultrasonography was consistently unable to assist transforaminal needle placement at the L5 level due to poor final needle tip visualization and the requirement of fluoroscopy to advance needle tip transforaminally. While no complications were seen, further controlled trials with larger sample size are needed to investigate safety.
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Affiliation(s)
- Amaresh Vydyanathan
- Montefiore Medical Center. Albert Einstein College of Medicine, Bronx, NY, USA
| | - Priya Agrawal
- Department of Anesthesiology, Perioperative and Pain Medicine, Alameda Health System, Oakland, CA, USA
| | - Khaled Donia
- Faculty of Medicine, Menoufia University, Menofia, Egypt
| | - Sayed E Wahezi
- Montefiore Medical Center. Albert Einstein College of Medicine, Bronx, NY, USA
| | - Sarang S Koushik
- Valleywise Health Medical Center, Creighton University School of Medicine, Phoenix, AZ, USA
| | | | - Karina Gritsenko
- Montefiore Medical Center. Albert Einstein College of Medicine, Bronx, NY, USA
| | - Naum Shaparin
- Montefiore Medical Center. Albert Einstein College of Medicine, Bronx, NY, USA
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Wang Y, Xu Y, Kang J, Fritz J, Iordachita I. Simulation-based Flexible Needle Control with Single-core FBG Feedback for Spinal Injections. IEEE TRANSACTIONS ON MEDICAL ROBOTICS AND BIONICS 2024; 6:1073-1083. [PMID: 39131204 PMCID: PMC11315370 DOI: 10.1109/tmrb.2024.3421630] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/13/2024]
Abstract
Objective We present a general framework of simultaneous needle shape reconstruction and control input generation for robot-assisted spinal injection procedures, without continuous imaging feedback. Methods System input-output mapping is generated with a real-time needle-tissue interaction simulation, and single-core FBG sensor readings are used as local needle shape feedback within the same simulation framework. FBG wavelength shifts due to temperature variation is removed by exploiting redundancy in fiber arrangement. Results Targeting experiments performed on both plastisol lumbar phantoms as well as an ex vivo porcine lumbar section achieved in-plane tip errors of 0.6 ± 0.3 mm and 1.6 ± 0.9 mm , and total tip errors of 0.9 ± 0.7 mm and 2.1 ± 0.8 mm for the two testing environments. Significance Our clinically inspired control strategy and workflow is self-contained and not dependent on the modality of imaging guidance. The generalizability of the proposed approach can be applied to other needle-based interventions where medical imaging cannot be reliably utilized as part of a closed-loop control system for needle guidance.
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Affiliation(s)
- Yanzhou Wang
- Department of Mechanical Engineering and Laboratory for Computational Sensing and Robotics, Johns Hopkins University, Baltimore, Maryland, USA
| | - Yangsheng Xu
- Department of Mechanical Engineering, Johns Hopkins University, Baltimore, Maryland, USA
| | - Jiarong Kang
- Department of Mechanical Engineering, Johns Hopkins University, Baltimore, Maryland, USA
| | - Jan Fritz
- Department of Radiology, New York University, New York City, New York, USA
| | - Iulian Iordachita
- Department of Mechanical Engineering and Laboratory for Computational Sensing and Robotics, Johns Hopkins University, Baltimore, Maryland, USA
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Wang B, Sun Y, Zhang J, Meng H, Zhang H, Shan L. Ultrasound-guided versus fluoroscopy-guided lumbar selective nerve root block: a retrospective comparative study. Sci Rep 2024; 14:3235. [PMID: 38331978 PMCID: PMC10853516 DOI: 10.1038/s41598-024-53809-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2023] [Accepted: 02/05/2024] [Indexed: 02/10/2024] Open
Abstract
The purpose of this study is to compare the accuracy and effectiveness of ultrasound-guided and fluoroscopy-guided lumbar selective nerve root block (SNRB), and to explore the feasibility of ultrasound-guided methods. This retrospective study included patients with lumbar radicular pain who underwent ultrasound-guided and fluoroscopy-guided selective nerve root block at Honghui Hospital Affiliated to Xi'an Jiaotong University from August 2020 to August 2022. Patients were divided into U-SNRB group and F-SNRB group according to ultrasound-guided or fluoroscopy-guided selective nerve root block. There were 43 patients in U-SNRB group and 20 patients in F-SNRB group. The pain visual analogue scale (VAS) scores, Japanese Orthopaedic Association (JOA) scores, related indexes and complications were recorded and compared between the two groups before, 30 min, 1 month and 6 months after block. To evaluate the feasibility, accuracy and effectiveness of ultrasound-guided selective nerve root block. There were no complications in the process of selective nerve root block in both groups. The operating time and the times of closing needle angle adjustment in U-SNRB group were better than those in F-SNRB group, and the difference was statistically significant (P < 0.05). The VAS score and JOA score of patients in the two groups were significantly improved 30 min after block, 1 month and 6 months after block, and the difference was statistically significant (P < 0.05). There was no significant difference between the two groups (P > 0.05). The accuracy of ultrasound-guided selective nerve root block and the degree of pain relief of patients were similar to those of fluoroscopy guidance, but the operation time and needle angle adjustment times were significantly less than that of fluoroscopy, and could effectively reduce radiation exposure. Therefore, it can be used as a better way to guide for choice.
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Affiliation(s)
- Bowen Wang
- Yan'an University, Yan'an, 716000, Shannxi, China
- The Spine Surgery Department of Honghui Hospital, Xi'an Jiaotong University, Xi'an, 710054, Shannxi, China
| | - Yang Sun
- The Spine Surgery Department of Honghui Hospital, Xi'an Jiaotong University, Xi'an, 710054, Shannxi, China
| | - Jitao Zhang
- The Spine Surgery Department of Honghui Hospital, Xi'an Jiaotong University, Xi'an, 710054, Shannxi, China
| | - Hailan Meng
- The Spine Surgery Department of Honghui Hospital, Xi'an Jiaotong University, Xi'an, 710054, Shannxi, China
| | - Hong Zhang
- The Ultrasound Department of Honghui Hospital, Xi'an Jiaotong University, Xi'an, 710054, Shannxi, China.
| | - Lequn Shan
- The Spine Surgery Department of Honghui Hospital, Xi'an Jiaotong University, Xi'an, 710054, Shannxi, China.
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Kimura R, Yamamoto N, Watanabe J, Ono Y, Hongo M, Miyakoshi N. Comparative efficacy of ultrasound guidance and fluoroscopy or computed tomography guidance in spinal nerve injections: a systematic review and meta-analysis. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2023; 32:4101-4110. [PMID: 37798592 DOI: 10.1007/s00586-023-07968-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/16/2023] [Revised: 08/16/2023] [Accepted: 09/21/2023] [Indexed: 10/07/2023]
Abstract
PURPOSE Spinal nerve injections have traditionally been performed under fluoroscopic (FL) and computed tomography (CT) guidance. Recently, ultrasound (US)-guided procedures have provided an alternative guidance approach that does not expose the patient and operator to radiation. The aim of this study was to compare the efficacy and safety of US-guided spinal nerve injections compared with FL- or CT-guided spinal nerve injections. METHODS MEDLINE, Cochrane Library, EMBASE, international clinical trials registry platform (ICTRP) and ClinicalTrials.gov database searches for inclusion until February 2023 were independently performed by two authors using predefined criteria. Randomized controlled trials (RCTs) were included. Primary outcomes were change in pain score (numeric rating scale or visual analogue scale) and major adverse events. Secondary outcomes were procedure time, change in functional disability score and minor adverse events. Meta-analysis was performed using random-effect model. We evaluated the certainty of evidence based on the Grading of Recommendations, Assessment and Development (GRADE) approach. RESULTS Eight RCTs involving 962 patients were included. There might be little to no difference in the mean score of the pain change between the US-guided methods and the FL- or CT-guided injections (standard mean difference -0.06; 95% confidence interval [CI] -0.26 to 0.15). US guidance probably reduced major adverse events (0.7% [3/433] and 6.5% [28/433], respectively), reduced procedure time (mean difference -4.19 min; 95% CI -5.09 to -3.30), and probably reduced minor adverse events (2.1% [9/433] and 4.2% [18/433], respectively) compared with FL or CT guidance. There was probably little to no difference in the change in functional disability score with either method. CONCLUSION US-guided spinal nerve injections remained effective and reduced adverse events compared with conventional FL- or CT-guided spinal nerve injections. Further RCTs are required to verify our results. STUDY REGISTRATION Open Science Forum (Available from: https://osf.io/vt92w/ ).
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Affiliation(s)
- Ryota Kimura
- Department of Orthopedic Surgery, Akita University Graduate School of Medicine, 1-1-1 Hondo, Akita, Akita, 010-8543, Japan.
- Scientific Research WorkS Peer Support Group (SRWS-PSG), Osaka, Japan.
| | - Norio Yamamoto
- Scientific Research WorkS Peer Support Group (SRWS-PSG), Osaka, Japan
- Department of Epidemiology, Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University, Okayama, Japan
| | - Jun Watanabe
- Scientific Research WorkS Peer Support Group (SRWS-PSG), Osaka, Japan
- Department of Surgery, Division of Gastroenterological, General and Transplant Surgery, Jichi Medical University, Yakushiji Shimotsuke City, Tochigi, Japan
- Center for Community Medicine, Ichi Medical University, Yakushiji Shimotsuke City, Tochigi, Japan
| | - Yuichi Ono
- Department of Orthopedic Surgery, Akita University Graduate School of Medicine, 1-1-1 Hondo, Akita, Akita, 010-8543, Japan
| | - Michio Hongo
- Department of Orthopedic Surgery, Akita University Graduate School of Medicine, 1-1-1 Hondo, Akita, Akita, 010-8543, Japan
| | - Naohisa Miyakoshi
- Department of Orthopedic Surgery, Akita University Graduate School of Medicine, 1-1-1 Hondo, Akita, Akita, 010-8543, Japan
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Viderman D, Aubakirova M, Aryngazin A, Yessimova D, Kaldybayev D, Tankacheyev R, Abdildin YG. Ultrasound-Guided vs. Fluoroscopy-Guided Interventions for Back Pain Management: A Systematic Review and Meta-Analysis of Randomized Controlled Trials. Diagnostics (Basel) 2023; 13:3474. [PMID: 37998610 PMCID: PMC10670286 DOI: 10.3390/diagnostics13223474] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2023] [Revised: 11/01/2023] [Accepted: 11/09/2023] [Indexed: 11/25/2023] Open
Abstract
The objective of this study was to compare the outcomes of the ultrasound- and fluoroscopy-guided techniques in the management of back pain. Using PubMed, Scopus, and the Cochrane Library, we searched randomized controlled trials (RCTs) published before May 2023, which reported relevant data on the topic. The effectiveness of the ultrasound-guided (US-guided) and fluoroscopy-guided (FL-guided) approaches for back pain management was compared in terms of postoperative pain intensity, postoperative functional outcomes, and postoperative complications. Subgroup analyses were conducted for different postoperative periods. Eight studies were included in the analysis. There was no significant difference in post-procedural pain relief at one week, two weeks, one month, two months, and three months between the US-guided and FL-guided interventions for back pain management (SMD with 95% CI is -0.01 [-0.11, 0.10]), p = 0.91, I2 = 0%). In terms of the postoperative functional outcomes assessed by the "Oswestry Disability Index" (ODI) functionality score, the model tends to favor the FL-guided injections over the US-guided injections (SMD with 95% CI: 0.13 [-0.00, 0.25], p = 0.05, I2 = 0). Finally, the US-guided and FL-guided injections did not show significantly different results in terms of postoperative complications (RR with 95% CI is 0.99 [0.49, 1.99], p = 0.97, I2 = 0). The subgroup analysis also did not demonstrate differences between the US-guided and FL-guided techniques in the following outcomes: vasovagal reaction, transient headache, and facial flushing. There was no significant difference between the US-guided and FL-guided injections for treating back pain in terms of postoperative pain intensity and complications. Still, the model tends to favor the FL-guided injections over the US-guided injections in terms of functionality.
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Affiliation(s)
- Dmitriy Viderman
- Department of Surgery, Section of Anesthesiology, Intensive Care, and Pain Medicine, Nazarbayev University School of Medicine (NUSOM), Astana 020000, Kazakhstan; (M.A.); or (D.Y.)
| | - Mina Aubakirova
- Department of Surgery, Section of Anesthesiology, Intensive Care, and Pain Medicine, Nazarbayev University School of Medicine (NUSOM), Astana 020000, Kazakhstan; (M.A.); or (D.Y.)
| | - Anuar Aryngazin
- Department of Mechanical and Aerospace Engineering, School of Engineering and Digital Sciences, Nazarbayev University, Astana 010000, Kazakhstan; (A.A.); (D.K.); (Y.G.A.)
| | - Dinara Yessimova
- Department of Surgery, Section of Anesthesiology, Intensive Care, and Pain Medicine, Nazarbayev University School of Medicine (NUSOM), Astana 020000, Kazakhstan; (M.A.); or (D.Y.)
- Department of Health Care Management, Faculty of Economics & Management, Technische Universität Berlin, 13355 Berlin, Germany
| | - Dastan Kaldybayev
- Department of Mechanical and Aerospace Engineering, School of Engineering and Digital Sciences, Nazarbayev University, Astana 010000, Kazakhstan; (A.A.); (D.K.); (Y.G.A.)
| | - Ramil Tankacheyev
- Department of Pain Medicine, National Neurosurgery Center, Astana 010000, Kazakhstan;
| | - Yerkin G. Abdildin
- Department of Mechanical and Aerospace Engineering, School of Engineering and Digital Sciences, Nazarbayev University, Astana 010000, Kazakhstan; (A.A.); (D.K.); (Y.G.A.)
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Güven Köse S, Köse HC, Çelikel F, Akkaya ÖT. Fluoroscopy-Guided Versus Fluoroscopy-Confirmed Ultrasound-Guided S1 Transforaminal Epidural Injection with Pulsed Radiofrequency: A Prospective, Randomized Trial. Eurasian J Med 2023; 55:43-49. [PMID: 36861865 PMCID: PMC10081137 DOI: 10.5152/eurasianjmed.2023.22265] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2022] [Accepted: 12/02/2022] [Indexed: 03/03/2023] Open
Abstract
OBJECTIVE The aim of this prospective randomized controlled study was to compare the effectiveness and accuracy of the ultrasound- and fluoroscopy-guided S1 transforaminal epidural injection combined with pulsed radiofrequency in patients with lumbosacral radicular pain caused by S1 nerve involvement. MATERIALS AND METHODS A total of 60 patients were randomized into 2 groups. Patients received S1 transforaminal epidural injection combined with pulsed radiofrequency under either ultrasound or fluoroscopy guidance. Primary outcomes were estimated with Visual Analog Scale scores at 6 months. Secondary outcomes included Oswestry Disability Index, Quantitative Analgesic Questionnaire, and patient satisfaction scores during the 6-month follow-up period and procedure-related variables including procedure time and accuracy of the needle replacement. RESULTS Both techniques provided significant pain reduction and functional improvement for 6 months compared to baseline (P < .001), without statistical significance between groups at each follow-up point. There was no significant difference in pain medication consumption (P=.441) and patient satisfaction scores (P=.673) between groups. The fluoroscopy guidance for combined transforaminal epidural injection with pulsed radiofrequency at S1 provided a greater accuracy for the cannula replacement (100%) than the ultrasound (93.3%), without significant difference between groups (P=.491). CONCLUSION The ultrasound-guided combined transforaminal epidural injection with pulsed radiofrequency at S1 level is a feasible alternative to fluoroscopy guidance. In this study, we reported that the ultrasoundguided technique resulted in similar treatment benefits including improvement in pain intensity and functionality and reduction in pain medication consumption as those in the fluoroscopy group, while reducing the risk for radiation exposure.
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Affiliation(s)
- Selin Güven Köse
- Department of Pain Medicine, Health Science University Derince Training and Research Hospital, Kocaeli, Turkey
| | - Halil Cihan Köse
- Department of Pain Medicine, Health Science University Derince Training and Research Hospital, Kocaeli, Turkey
| | - Feyza Çelikel
- Department of Physical Therapy and Rehabilitation, Sakarya Training and Research Hospital, Sakarya, Turkey
| | - Ömer Taylan Akkaya
- Department of Pain Medicine, Health Science University Dışkapı Yıldırım Beyazıt Training and Research Hospital, Ankara, Turkey
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Naredo E, Rodriguez-Garcia SC, Terslev L, Martinoli C, Klauser A, Hartung W, Hammer HB, Cantisani V, Zaottini F, Vlad V, Uson J, Todorov P, Tesch C, Sudoł-Szopińska I, Simoni P, Serban O, Sconfienza LM, Sala-Blanch X, Plagou A, Picasso R, Özçakar L, Najm A, Möller I, Micu M, Mendoza-Cembranos D, Mandl P, Malattia C, Lenghel M, Kessler J, Iohom G, de la Fuente J, DʼAgostino MA, Collado P, Bueno A, Bong D, Alfageme F, Bilous D, Gutiu R, Marian A, Pelea M, Fodor D. The EFSUMB Guidelines and Recommendations for Musculoskeletal Ultrasound - Part II: Joint Pathologies, Pediatric Applications, and Guided Procedures. ULTRASCHALL IN DER MEDIZIN (STUTTGART, GERMANY : 1980) 2022; 43:252-273. [PMID: 34734404 DOI: 10.1055/a-1640-9183] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
The second part of the Guidelines and Recommendations for Musculoskeletal Ultrasound (MSUS), produced under the auspices of EFSUMB, following the same methodology as for Part 1, provides information and recommendations on the use of this imaging modality for joint pathology, pediatric applications, and musculoskeletal ultrasound-guided procedures. Clinical application, practical points, limitations, and artifacts are described and discussed for every joint or procedure. The document is intended to guide clinical users in their daily practice.
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Affiliation(s)
- Esperanza Naredo
- Department of Rheumatology, Bone and Joint Research Unit. Hospital Universitario Fundación Jiménez Díaz, IIS Fundación Jiménez Díaz, and Universidad Autónoma de Madrid, Madrid, Spain
| | | | - Lene Terslev
- Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases, Rigshospitalet, Glostrup, Denmark; Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Carlo Martinoli
- Department of Health Science - DISSAL, University of Genova, Italy
- UO Radiologia, IRCCS Policlinico San Martino, Genova, Italy
| | - Andrea Klauser
- Department of Radiology, Medical University Innsbruck, Section Head Rheumatology and Sports Imaging, Innsbruck, Austria
| | - Wolfgang Hartung
- Clinic for Rheumatology and Clinical Immunology, Asklepios Clinic, Bad Abbach, Germany
| | - Hilde B Hammer
- Department of Rheumatology, Diakonhjemmet Hospital and Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Vito Cantisani
- Department of Radiological, Oncological and Anatomo-pathological Sciences, "Sapienza" University, Rome, Italy
| | - Federico Zaottini
- Department of Health Science - DISSAL, University of Genova, Italy
- UO Radiologia, IRCCS Policlinico San Martino, Genova, Italy
| | - Violeta Vlad
- Sf. Maria Hospital, Rheumatology Department, Bucharest, Romania
| | - Jacqueline Uson
- Department of Rheumatology Hospital Universitario Móstoles, Universidad Rey Juan Carlos, Madrid, Spain
| | - Plamen Todorov
- Department of Internal Disease Propaedeutic and Clinical Rheumatology, Medical University of Plovdiv, Plovdiv, Bulgaria
| | | | - Iwona Sudoł-Szopińska
- Department of Radiology, National Institute of Geriatrics, Rheumatology and Rehabilitation, Warsaw, Poland
| | - Paolo Simoni
- Paediatric Imaging Department, "Reine Fabiola" Children's University Hospital, Université Libre de Bruxelles, Brussels, Belgium
| | - Oana Serban
- 2nd Internal Medicine Department, "Iuliu Hatieganu" University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Luca Maria Sconfienza
- IRCCS Istituto Ortopedico Galeazzi, Milano Italy
- Department of Biomedical Sciences for Health, University of Milano, Milano, Italy
| | - Xavier Sala-Blanch
- Department of Anaesthesiology, Hospital Clinic, Department of Human Anatomy, Faculty of Medicine, University of Barcelona, Spain
| | - Athena Plagou
- Ultrasound Unit, Private Radiological Institution, Athens, Greece
| | - Riccardo Picasso
- Department of Health Science - DISSAL, University of Genova, Italy
- UO Radiologia, IRCCS Policlinico San Martino, Genova, Italy
| | - Levent Özçakar
- Department of Physical and Rehabilitation Medicine, Hacettepe University Medical School, Ankara, Turkey
| | - Aurelie Najm
- Institute of Infection, Immunity and Inflammation, College of Medical Veterinary and Life Sciences, University of Glasgow, Glasgow, United Kingdom
| | - Ingrid Möller
- Instituto Poal de Reumatologia Barcelona, EULAR Working Group Anatomy for the Image, University of Barcelona, International University of Catalunya, Spain
| | - Mihaela Micu
- Rheumatology Division, 2nd Rehabilitation Department, Rehabilitation Clinical Hospital Cluj-Napoca, Romania
| | | | - Peter Mandl
- Division of Rheumatology, Medical University of Vienna, Vienna, Austria
| | - Clara Malattia
- UOC Clinica Pediatrica e Reumatologia, IRCCS Istituto Giannina Gaslini, Department of Neurosciences, Rehabilitation, Ophthalmology, Genetic and Maternal Infantile Sciences (DINOGMI) University of Genoa, Genoa, Italy
| | - Manuela Lenghel
- Radiology Department, "Iuliu Hatieganu" University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Jens Kessler
- Department of Anaesthesiology, Division of Pain Medicine, University Hospital Heidelberg, Heidelberg, Germany
| | - Gabriella Iohom
- Department of Anaesthesiology and Intensive Care Medicine, Cork University Hospital and University College Cork, Cork, Ireland
| | | | - Maria Antonietta DʼAgostino
- Istituto di Reumatologia Università Cattolica del Sacro Cuore, UOC Reumatologia, Fondazione Policlinico Universitario Agostino Gemelli, IRCCS, Rome, Italy
| | - Paz Collado
- Rheumatology Department, Transitional Care Clinic, Hospital Universitario Severo Ochoa, Madrid, Spain
| | - Angel Bueno
- Department of Musculoskeletal Radiology, Hospital Universitario Fundación Alcorcón, Madrid, Spain
| | - David Bong
- Instituto Poal de Reumatologia Barcelona, EULAR Working Group Anatomy for the Image, University of Barcelona, International University of Catalunya, Spain
| | - Fernando Alfageme
- Dermatology Department, Hospital Universitario Puerta de Hierro Majadahonda, Madrid, Spain
| | - Diana Bilous
- 2nd Internal Medicine Department, "Iuliu Hatieganu" University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Roxana Gutiu
- 2nd Internal Medicine Department, "Iuliu Hatieganu" University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Anamaria Marian
- 2nd Internal Medicine Department, "Iuliu Hatieganu" University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Michael Pelea
- 2nd Internal Medicine Department, "Iuliu Hatieganu" University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Daniela Fodor
- 2nd Internal Medicine Department, "Iuliu Hatieganu" University of Medicine and Pharmacy, Cluj-Napoca, Romania
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Ultrasonographic Imaging Protocol and Sonoanatomy of the Lumbar Spine in Healthy Dogs. Animals (Basel) 2022; 12:ani12091187. [PMID: 35565613 PMCID: PMC9100366 DOI: 10.3390/ani12091187] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2022] [Revised: 04/23/2022] [Accepted: 05/01/2022] [Indexed: 11/17/2022] Open
Abstract
Ultrasound is an imaging technique commonly used in veterinary medicine. Ultrasound devices are widely available, their means of examination are relatively short and cheap, and they do not generate ionizing radiation. In addition, ultrasound generally does not need to be performed under general anesthesia. This study was performed on 23 canine cadavers with full clinical histories and with no confirmed pathological changes in the spine region. The imaging modalities were established in dogs in lateral recumbency, with the selected side being the uppermost angle, in a neutral position. All dogs were examined in the transverse and longitudinal planes. Sacral crest, intertransverse ligament, vertebral canal floor, vertebral body, and intervertebral discs were only visible in the longitudinal plane. Vertebral arch, supraspinal ligament, dorsal wall of the vertebral canal and muscles were visualized only in the transverse plane. This article provides a brief and relatively easy-to-perform protocol for ultrasound imaging of the lumbar spine of dogs. In addition, it presents a detailed description of the sonoanatomy of the area under investigation.
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10
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Ultrasound and nerve stimulator guidance lumbar transforaminal epidural block for the treatment of patients with lumbosacral radicular pain. Sci Rep 2022; 12:5954. [PMID: 35396387 PMCID: PMC8993929 DOI: 10.1038/s41598-022-10021-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2021] [Accepted: 03/31/2022] [Indexed: 01/19/2023] Open
Abstract
Transforaminal epidural block (TEB) is a widely accepted technique and minimally invasive procedure for the treatment of lumbosacral radicular pain. This study aimed to evaluate the accuracy, efficacy, and safety of ultrasound and nerve stimulator guidance lumbar transforaminal epidural block (UNTEB) for the patients with unilateral lower lumbar radicular pain. The accuracy of this method was evaluated by fluoroscopy. Using UNTEB via axial and the in-plane approach technique was performed in 42 segments of 25 patients who presented with lumbosacral radicular pain to lower extremities. The contrast medium was injected to evaluate the needle tip at the intervertebral foramen under fluoroscopic guidance. The numerical rating scale was used to assess pain before and after treatment. The success ratio of UNTEB in L3/L4 level was 100%, in L4/L5 was 95.4% and in L5/S1 was 100%. The numerical rating scale (NRS) for lumbosacral radicular pain improved from a mean from 7.8 to 2.8 1 day after procedure (p = 0.01) and from a mean from 7.8 to 2.4 1 week after UNTEB (p = 0.01). None of our subjects experienced any complications during and after the procedure. UNTEB with fluoroscopic validation is an accurate, effective, and safe method for short-term pain relief of the patients with unilateral lumbosacral radicular pain.
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11
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Wang Y, Wang AZ, Wu BS, Zheng YJ, Zhao DQ, Liu H, Xu H, Fang HW, Zhang JY, Cheng ZX, Wang XR. Chinese Association for the Study of Pain: Experts consensus on ultrasound-guided injections for the treatment of spinal pain in China (2020 edition). World J Clin Cases 2021; 9:2047-2057. [PMID: 33850924 PMCID: PMC8017500 DOI: 10.12998/wjcc.v9.i9.2047] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2020] [Revised: 01/31/2021] [Accepted: 03/16/2021] [Indexed: 02/06/2023] Open
Abstract
Spinal pain (SP) is a common condition that has a major negative impact on a patient’s quality of life. Recent developments in ultrasound-guided injections for the treatment of SP are increasingly being used in clinical practice. This clinical expert consensus describes the purpose, significance, implementation methods, indications, contraindications, and techniques of ultrasound-guided injections. This consensus offers a practical reference point for physicians to implement successfully ultrasound-guided injections in the treatment of chronic SP.
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Affiliation(s)
- Yun Wang
- Department of Anesthesiology, Beijing Chaoyang Hospital, Capital Medical University, Beijing 100020, China
| | - Ai-Zhong Wang
- Department of Anesthesiology, The Sixth Affiliated People's Hospital, Shanghai Jiao Tong University, Shanghai 200233, China
| | - Bai-Shan Wu
- Department of Algology, Xuanwu Hospital, Capital Medical University, Beijing 100053, China
| | - Yong-Jun Zheng
- Department of Algology, Huadong Hospital Affiliated to Fudan University, Shanghai 200040, China
| | - Da-Qiang Zhao
- Department of Anesthesiology, Jiahui International Hospital, Shanghai 200233, China
| | - Hui Liu
- Department of Algology, West China Hospital, Sichuan University, Chengdu 610041, Sichuan Province, China
| | - Hua Xu
- Department of Anesthesiology, Yueyang Hospital of Integrated Traditional Chinese and Western Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai 200437, China
| | - Hong-Wei Fang
- Department of Algology, East Hospital, Tongji University, Shanghai 200120, China
| | - Jin-Yuan Zhang
- Department of Algology, East Hospital, Tongji University, Shanghai 200120, China
| | - Zhi-Xiang Cheng
- Department of Algology, The Second Affiliated Hospital, Nanjing Medical University, Nanjing 210011, Jiangsu Province, China
| | - Xiang-Rui Wang
- Department of Algology, East Hospital, Tongji University, Shanghai 200120, China
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12
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Ultrasound-guided periradicular oxygen-ozone injections as a treatment option for low back pain associated with sciatica. INTERNATIONAL ORTHOPAEDICS 2021; 45:1239-1246. [PMID: 33629173 DOI: 10.1007/s00264-021-04975-w] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/17/2020] [Accepted: 02/02/2021] [Indexed: 12/23/2022]
Abstract
BACKGROUND The social impact and economic burden of low back pain are well known among the medical community. A novel therapeutic approach is represented by oxygen-ozone therapy, whose anti-inflammatory effects could be especially useful in patients with herniated discs. The most common administration is through a palpation-guided injection technique, although the use of ultrasound guidance could allow a more precise delivery of the therapeutic substance close to the nerve root. AIM OF THE STUDY To describe the clinical outcomes following US-guided periradicular injection of oxygen-ozone as a treatment option for low back pain associated to sciatica in patients affected by symptomatic L5-S1 disc herniation. CONCLUSION Ultrasound-guided periradicular injection of oxygen-ozone in L5-S1 herniation is a safe and effective minimally invasive treatment, able to improve both low back and radiating pain.
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13
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Ultrasound imaging and guidance in the management of post-injection sciatic neuropathy: Love, loss and space. Turk J Phys Med Rehabil 2020; 66:225-226. [PMID: 32760903 DOI: 10.5606/tftrd.2020.5897] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2020] [Accepted: 03/17/2020] [Indexed: 11/21/2022] Open
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14
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Soni P, Punj J. Ultrasound-Guided Lumbar Transforaminal Epidural Injection: A Narrative Review. Asian Spine J 2020; 15:261-270. [PMID: 32521947 PMCID: PMC8055462 DOI: 10.31616/asj.2019.0245] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2019] [Accepted: 01/13/2020] [Indexed: 12/16/2022] Open
Abstract
Transforaminal epidural steroid injection is often administered to patients with radiculopathy under fluoroscopic guidance, although it has disadvantages of radiation hazards and requirement of a special area to perform the block. To avoid these disadvantages, ultrasound-guided transforaminal injection (USTFI) has recently been described and is continually developed. This review article describes the indexed articles published on USTFI and ultrasound-guided selective nerve block (SNRB) to evaluate current evidence on best approach to perform the block. Through literature search, eight articles and one case report on USTFI and five articles on ultrasound-guided SNRB were found. Most of the studies have utilized parasagittal orientation of curvilinear probe to perform the block. Nevertheless, with the present literature, it is difficult to come to any conclusion. Further studies with larger sample size and description of dye spread patterns are recommended to come to a more definite conclusion.
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Affiliation(s)
- Preeti Soni
- Department of Anaesthesiology, Pain Medicine & Critical Care, All India Institute of Medical Sciences, New Delhi, India
| | - Jyotsna Punj
- Department of Anaesthesiology, Pain Medicine & Critical Care, All India Institute of Medical Sciences, New Delhi, India
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15
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Wei JCC, Liu CH, Tseng JC, Hsieh LF, Chen CH, Chen HH, Chen HA, Chen YC, Chou CT, Liao HT, Lin YC, Luo SF, Yang DH, Yeo KJ, Tsai WC. Taiwan Rheumatology Association consensus recommendations for the management of axial spondyloarthritis. Int J Rheum Dis 2019; 23:7-23. [PMID: 31777200 PMCID: PMC7004149 DOI: 10.1111/1756-185x.13752] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2018] [Accepted: 03/31/2019] [Indexed: 12/16/2022]
Abstract
Aim To establish guidelines for the clinical management of axial spondyloarthritis that take into account local issues and clinical practice concerns for Taiwan. Method Overarching principles and recommendations were established by consensus among a panel of rheumatology and rehabilitation experts, based on analysis of the most up‐to‐date clinical evidence and the clinical experience of panelists. All Overarching Principles and Recommendations were graded according to the standards developed by the Oxford Centre for Evidence Based Medicine, and further evaluated and modified using the Delphi method. Results The guidelines specifically address issues such as local medical considerations, National Health Insurance reimbursement, and management of extra‐articular manifestations. Conclusion It is hoped that this will help to optimize clinical management outcomes for axial spondyloarthritis in Taiwan.
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Affiliation(s)
- James Cheng-Chung Wei
- Division of Allergy, Immunology and Rheumatology, Chung Shan Medical University Hospital, Institute of Medicine, Chung Shan Medical University, Taichung, Taiwan.,Graduate Institute of Integrated Medicine, China Medical University, Taichung, Taiwan
| | - Chin-Hsiu Liu
- Division of Allergy, Immunology and Rheumatology, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, New Taipei City, Taiwan.,School of Medicine, Tzu Chi University, Hualien, Taiwan
| | - Jui-Cheng Tseng
- Division of Allergy, Immunology, and Rheumatology, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan
| | - Lin-Fen Hsieh
- Department of Physical Medicine and Rehabilitation, Shin Kong Wu Ho-Su Memorial Hospital, Taipei, Taiwan.,School of Medicine, Fu Jen Catholic University, New Taipei City, Taiwan
| | - Chun-Hsiung Chen
- Division of Allergy, Immunology and Rheumatology, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, New Taipei City, Taiwan
| | - Hsin-Hua Chen
- Division of Allergy-Immunology-Rheumatology, Taichung Veterans General Hospital, Taichung, Taiwan
| | - Hung-An Chen
- Department of Allergy, Immunology, and Rheumatology, Chi Mei Medical Center, Tainan, Taiwan
| | - Ying-Chou Chen
- Department of Rheumatology, Allergy and Immunology, Chang Gung Memorial Hospital-Kaohsiung, Kaohsiung, Taiwan
| | - Chung-Tei Chou
- Division of Allergy, Immunology, Rheumatology, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Hsien-Tzung Liao
- Division of Allergy, Immunology, Rheumatology, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Yi-Chun Lin
- Department of Allergy, Immunology, and Rheumatology, Cheng Hsin General Hospital, Taipei, Taiwan
| | - Shue-Fen Luo
- Department of Rheumatology, Allergy and Immunology, Chang Gung Memorial Hospital-Linkou, Taoyuan, Taiwan
| | - Deng-Ho Yang
- Division of Rheumatology/Immunology/Allergy, Department of Internal Medicine, Taichung Armed-Forces General Hospital, Taichung, Taiwan.,Department of Medical Laboratory Science and Biotechnology, Central Taiwan University of Science and Technology, Taichung, Taiwan.,Division of Rheumatology/Immunology/Allergy, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
| | - Kai-Jieh Yeo
- Division of Rheumatology and Immunology, China Medical University Hospital, Taichung, Taiwan
| | - Wen-Chan Tsai
- Division of Allergy, Immunology, and Rheumatology, Kaohsiung Medical University Chung-Ho Memorial Hospital, Kaohsiung, Taiwan.,Department of Internal Medicine, Kaohsiung Municipal Ta-Tung Hospital, Kaohsiung, Taiwan
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16
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[Lumbar facet joint disease : Classification, clinical diagnostics, and minimally invasive treatment]. DER ORTHOPADE 2019; 48:77-83. [PMID: 30637440 DOI: 10.1007/s00132-018-03667-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
BACKGROUND The degeneration of the lumbar facet joint is a multi-factorial process that is closely linked to degeneration of the intervertebral discs and has been implicated as one of the causes of low-back pain of elderly patients in about 15 up to 40% of cases. Moreover, emerging data suggest that increased inflammatory features play an important role in the progression of lumbar facet joint disease and may serve as a link to the afferent pain nerve fibers. OPERATIVE TECHNIQUES Since the first description in 1975 of minimally invasive treatment of lumbar facet joint disease, different techniques have been developed and used with varying results. Today, the major techniques are thermorhizotomy, cryorhizotomy, and endoscopic or percutaneous facet debridement with different anatomical targets, such as the medial branch of the dorsal ramus or facet joint capsule.
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17
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Kastler A, Gruber H, Gizewski E, Loizides A. Ultrasound Assessment of Ice-Ball Formation by Cryoneurolysis Device in an Ex Vivo Model. Reg Anesth Pain Med 2018; 43:631-633. [DOI: 10.1097/aap.0000000000000793] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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18
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Elsholtz FHJ, Schaafs LA, Erxleben C, Hamm B, Niehues SM. Periradicular infiltration of the lumbar spine: is iterative reconstruction software necessary to establish ultra-low-dose protocols? A quantitative and qualitative approach. Radiol Med 2018; 123:827-832. [PMID: 29923084 DOI: 10.1007/s11547-018-0913-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2018] [Accepted: 06/12/2018] [Indexed: 12/18/2022]
Abstract
PURPOSE Computed tomography (CT)-guided periradicular infiltration therapy has emerged as an effective treatment option for patients with low back pain. Concern about radiation exposure requires approaches allowing significant dose reduction. The purpose of this study is to evaluate the need for iterative reconstruction software in CT-guided periradicular infiltration therapy with an ultra-low-dose protocol. MATERIALS AND METHODS One hundred patients underwent CT-guided periradicular infiltration therapy of the lumbar spine using an ultra-low-dose protocol with adaptive iterative dose reduction 3D (AIDR 3D) for image reconstruction. In addition, images were reconstructed with filtered back-projection (FBP). Four experienced raters evaluated both reconstruction types for conspicuity of anatomical and instrumental features important for ensuring safe patient treatment. Image noise was measured as a quantitative marker of image quality. RESULTS Interrater agreement was good for both AIDR 3D (Kendall's W = 0.83) and FBP (0.78) reconstructions. Readers assigned the same scores for all features and both reconstruction algorithms in 81.3% of cases. Image noise was significantly lower (average SD of 60.07 vs. 99.54, p < 0.05) for AIDR 3D-reconstructed images. CONCLUSION Although it significantly lowers image noise, iterative reconstruction software is not mandatory to achieve adequate image quality with an ultra-low-dose CT protocol for guiding periradicular infiltration therapy of the lumbar spine.
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Affiliation(s)
- Fabian Henry Jürgen Elsholtz
- Klinik und Hochschulambulanz für Radiologie, Charité- Universitätsmedizin Berlin, Campus Benjamin Franklin, Hindenburgdamm 30, 12203, Berlin, Germany.
| | - Lars-Arne Schaafs
- Klinik und Hochschulambulanz für Radiologie, Charité- Universitätsmedizin Berlin, Campus Benjamin Franklin, Hindenburgdamm 30, 12203, Berlin, Germany
| | - Christoph Erxleben
- Klinik und Hochschulambulanz für Radiologie, Charité- Universitätsmedizin Berlin, Campus Benjamin Franklin, Hindenburgdamm 30, 12203, Berlin, Germany
| | - Bernd Hamm
- Klinik und Hochschulambulanz für Radiologie, Charité- Universitätsmedizin Berlin, Campus Benjamin Franklin, Hindenburgdamm 30, 12203, Berlin, Germany
| | - Stefan Markus Niehues
- Klinik und Hochschulambulanz für Radiologie, Charité- Universitätsmedizin Berlin, Campus Benjamin Franklin, Hindenburgdamm 30, 12203, Berlin, Germany
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19
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Ahmed AS, Ramakrishnan R, Ramachandran V, Ramachandran SS, Phan K, Antonsen EL. Ultrasound diagnosis and therapeutic intervention in the spine. JOURNAL OF SPINE SURGERY 2018; 4:423-432. [PMID: 30069538 DOI: 10.21037/jss.2018.04.06] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Spine pathology afflicts people across the globe and is responsible for a large portion of physician visits and healthcare costs. Imaging such as plain radiographs, CT, MRI, and ultrasound is vital to assess structure, function, and stability of the spine and also provide guidance in therapeutic interventions. Ultrasound utilization in spine conditions is less ubiquitous, but provides benefits in low costs, portability, and dynamic imaging. This study assesses ultrasound efficacy in diagnosis and therapeutic interventions for spine pathology. A systematic review conducted via PubMed, MEDLINE, and Google Scholar identified 3,630 papers with eventual inclusion of 73 papers with an additional 21 papers supplemental papers subsequently added. Findings highlighted ultrasound utilization for different structural elements of the spine such as muscle, bone, disc, ligament, canal, and joints are presented and compared with radiographs, CT, and MRI imaging where relevant. Spinal curvature and mobility are similarly presented. Ultrasound efficacy for guided therapeutics about the spine is presented and assessed against other modalities. Ultrasound is a widely used and efficacious modality to guide injections about the spine. Diagnostic utility is less well studied, but shows promise in assessing fractures, posterior ligamentous stability, and intra-operative hardware placement. The low cost, portability, and dynamic imaging ability make it an attractive modality particularly for developing health systems and resource limited environments such as combat settings and the International Space Station. Further study is recommended before broad adoption in diagnostics.
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Affiliation(s)
- Adil S Ahmed
- Department of Orthopaedic Surgery, University of South Florida Morsani College of Medicine, Tampa, Florida, USA
| | | | | | - Shyam S Ramachandran
- Department of Kinesiology and Health Education, University of Texas, Austin, Texas, USA
| | - Kevin Phan
- NeuroSpine Surgery Research Group (NSURG), Prince of Wales Private Hospital, Randwick, Sydney, Australia.,Department of Neurosurgery, Prince of Wales Private Hospital, Randwick, Sydney, Australia
| | - Erik L Antonsen
- Department of Emergency Medicine, Baylor College of Medicine, Houston, Texas, USA.,National Aeronautics and Space Administration, Houston, Texas, USA
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20
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Sonography guided lumbar nerve and facet blocks: The first report of clinical outcome from Iran. Radiography (Lond) 2017; 24:52-56. [PMID: 29306376 DOI: 10.1016/j.radi.2017.08.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2017] [Revised: 08/09/2017] [Accepted: 08/11/2017] [Indexed: 11/20/2022]
Abstract
INTRODUCTION Nerve root block (NRB) and facet block (FB) are viable options for pain arising from facet and lumbar disc herniation (LDH) not responding to conservative therapy but still not suitable for surgery. Classically, they are performed under fluoroscopy and computed tomography (CT) guidance, which have the disadvantages of radiation exposure and limited accessibility. The aim of this study was to assess the effectiveness of US guided FB and NRB in patients suffering from facet arthropathy and LDH. METHODS 14 patients were involved in the study. After defining nerve root (for NRB) or facet joints (for FB) under a standard US investigation, real-time injection of methylprednisolone and bupivacaine was performed. Pain was measured before and after procedure by VAS. RESULTS Ten patients underwent FBs (8 bilateral and 2 unilateral) and 4 underwent NRBs (2 bilateral and 2 unilateral). 11/14 (79%) patients improved after the block (8 in FB, 3 in NRB) and the VAS had significantly decreased 1 week after procedure (mean [range] -1.7 [-6 to 0]). For the 11 patients that improved after FB or NRB, the effect lasted for a mean of 59 days (range: 30-130 days). Analysis showed that neither block procedure (NRB vs. FB) nor block level (L4L5 vs. L5S1) had an effect on result. CONCLUSIONS Results of our preliminary study shows that in appropriately selected patients, nerve root and facet blocks can be effectively performed under ultrasonography guidance without notable complications, with effects lasting for a mean 2 months.
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Shi W, Tian D, Liu D, Yin J, Huang Y. The comparison of measurement between ultrasound and computed tomography for abnormal degenerative facet joints: A STROBE-compliant article. Medicine (Baltimore) 2017; 96:e7680. [PMID: 28767595 PMCID: PMC5626149 DOI: 10.1097/md.0000000000007680] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Besides the study on examining facet joints of lumbar spine by ultrasound in normal population, there has not been any related report about examining normal facet joints of lumbar spine by ultrasound so far. This study was aimed to explore the feasibility of ultrasound assessment of lumber spine facet joints by comparing ultrasound measure values of normal and degenerative lumber spine facet joints, and by comparing measure values of ultrasound and computed tomography (CT) of degenerative lumber spine facet joints.This study included 15 patients who had chronic low back pain because of degenerative change in lumbar vertebrae, and 19 volunteers who did not have low back pain or pain in the lower limb. The ultrasound measure values (height [H] and width [W]) of normal and degenerative lumber spine facet joints were compared. And the differentiation between measure values (H and W) of ultrasound and CT of degenerative lumber spine facet joints was also analyzed.The ultrasound clearly showed abnormal facet joints lesion, which was characterized by hyperostosis on the edge of joints, bone destruction under joints, and thinner or thicker articular cartilage. There were significant differences between the ultrasound measure values of the normal (H: 1.26 ± 0.03 cm, W: 0.18 ± 0.01 cm) and abnormal facet joints (H: 1.43 ± 0.05 cm, W: 0.15 ± 0.02 cm) (all P < .05). However, there were no significant differences between the measure values of the ultrasound (H: 1.43 ± 0.17 cm, W: 0.15 ± 0.03 cm) and CT (H: 1.42 ± 0.16, W: 0.14 ± 0.03) of the degenerative lumber spine facet joints (all P > .05).Ultrasound can clearly show the structure of facet joints of lumbar spine. It is precise and feasible to assess facet joints of lumbar spine by ultrasound. This study has important significance for the diagnosis of lumbar facet joint degeneration.
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Affiliation(s)
| | | | - Da Liu
- Department of Orthopedics, Shengjing Hospital of China Medical University, Shenyang, China
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22
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Ultrasonography-Guided Lumbar Periradicular Injections for Unilateral Radicular Pain. BIOMED RESEARCH INTERNATIONAL 2017; 2017:8784149. [PMID: 28466022 PMCID: PMC5390551 DOI: 10.1155/2017/8784149] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/03/2016] [Revised: 02/09/2017] [Accepted: 02/22/2017] [Indexed: 12/13/2022]
Abstract
Objective. The aim of this study was to compare the accuracy and efficacy of sonographically guided lumbar periradicular injections through in-plane or out-of-plane approach techniques for patients with unilateral lower lumbar radicular pain. The feasibility and accuracy of these techniques were studied by means of computed tomography (CT). Methods. A total of 46 patients with chronic unilateral lumbar radicular pain were recruited and randomly assigned to either the in-plane or out-of-plane injection group. A mixture of 3 mL 1% lidocaine and 7 mg betamethasone was injected. The visual analog scale (VAS) was used to assess pain before and after treatment. Results. The pain intensity, as measured by VAS, significantly decreased in both in-plane and out-of-plane injection groups. Conclusions. The sonographically guided periradicular injections are feasible and effective in treating lumbar unilateral radicular pain.
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Bhatia A. Regarding Ultrasound-Guided Pararadicular Injections in the Lumbar Spine by Kim et al. Pain Pract 2017; 16:E92. [PMID: 27260119 DOI: 10.1111/papr.12465] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Anuj Bhatia
- Department of Anesthesia and Pain Management, University Health Network - Toronto Western Hospital, Mount Sinai Hospital, Women's College Hospital, Toronto, Ontario, Canada.
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Ultrasound-guided Versus Fluoroscopy-controlled Lumbar Transforaminal Epidural Injections: A Prospective Randomized Clinical Trial. Clin J Pain 2016; 32:103-8. [PMID: 25803759 DOI: 10.1097/ajp.0000000000000237] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
OBJECTIVES Recently, most lumbar spine injections have been administered under ultrasound (US) guidance; however, there is no standard method for US-guided lumbar transforaminal epidural injection (TFEI). In this study, we evaluated the accuracy, effect on pain relief, and safety of US-guided lumbar TFEI. METHODS A total of 80 patients with low back pain and radicular pain were enrolled. The patients were randomly assigned to either the fluoroscopy (FL) group or the US group. The FL-guided approaches were performed under standardized procedures using the C-arm, whereas the US-guided injections were performed with an US device with a linear probe, and were verified by FL. The needle tip reached the lateral side of the lamina in the axis view and the middle of the adjacent facet joints in the parasagittal view. Afterward, the needle was advanced slightly deeper until the loss-of-resistance test was positive. RESULTS The success ratio of the US-guided interventions was 85%. The operation time in the US group (518±103 s) was shorter than the FL group (929±228 s) (P<0.05). In addition, the radiation dosage in the US group (2640±906 μGy m²) was lower than in the FL group (8992±2132 μGy m²). There was no significant difference in pain relief between the US and FL groups. No serious complication was observed in any of the patients in either group. DISCUSSION Lumbar TFEI under US guidance was feasible, safe, and required less radiation to achieve the same benefit as the FL-guided interventions.
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25
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Ahn SG, Lee J, Park HJ, Kim YH. Ultrasound-guided pararadicular block using a paramedian sagittal oblique approach for managing low back pain in a pregnant woman -A case report-. Anesth Pain Med (Seoul) 2016. [DOI: 10.17085/apm.2016.11.3.291] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Affiliation(s)
- Seul Gi Ahn
- Department of Anesthesiology and Pain Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Jisoo Lee
- Department of Anesthesiology and Pain Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Hue Jung Park
- Department of Anesthesiology and Pain Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Young Hoon Kim
- Department of Anesthesiology and Pain Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
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Tildsley P, Lim MJ, Sng BL. Ultrasound of the lumbar spine: Applications and advances. TRENDS IN ANAESTHESIA AND CRITICAL CARE 2016. [DOI: 10.1016/j.tacc.2016.05.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Darrieutort-Laffite C, Bart G, Planche L, Glemarec J, Maugars Y, Le Goff B. Usefulness of a pre-procedure ultrasound scanning of the lumbar spine before epidural injection in patients with a presumed difficult puncture: A randomized controlled trial. Joint Bone Spine 2015; 82:356-61. [DOI: 10.1016/j.jbspin.2015.02.001] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2014] [Accepted: 02/02/2015] [Indexed: 12/27/2022]
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Korbe S, Udoji EN, Ness TJ, Udoji MA. Ultrasound-guided interventional procedures for chronic pain management. Pain Manag 2015; 5:465-82. [PMID: 26402316 PMCID: PMC4976830 DOI: 10.2217/pmt.15.46] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
Ultrasonography has multiple advantages over traditional radiologic imaging modalities when used for interventional procedures. It allows improved visualization of the anatomy while avoiding ionizing radiation and risks associated with contrast use. It has proved superiority at accuracy of delivery and procedural effectiveness over blind procedures when used in association with interventional pain procedures. Although limited in its ability to see through bony structures, ultrasound has utility in visualizing soft tissues and vascular structures in anatomic regions of interest resulting in increased use for posterior neuraxial, periaxial, peripheral nerve and joint-related structures. Current evidence for use in these settings is presented here. In some cases, optimal utility may be improved by combining ultrasonography with other imaging modalities.
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Affiliation(s)
- Samuel Korbe
- Department of Anesthesiology & Perioperative Medicine, University of Alabama at Birmingham, Birmingham, AL 35249, USA
| | - Esther N Udoji
- Department of Radiology, University of Chicago, Chicago, IL 60637, USA
| | - Timothy J Ness
- Department of Anesthesiology & Perioperative Medicine, University of Alabama at Birmingham, Birmingham, AL 35249, USA
| | - Mercy A Udoji
- Department of Anesthesiology & Perioperative Medicine, University of Alabama at Birmingham, Birmingham, AL 35249, USA
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Liu D, Huang Y, Tian D, Yin J. Quantitative ultrasound assessment of the facet joint in the lumbar spine: a feasibility study. ULTRASOUND IN MEDICINE & BIOLOGY 2015; 41:1226-1232. [PMID: 25638321 DOI: 10.1016/j.ultrasmedbio.2014.12.025] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/17/2014] [Revised: 11/20/2014] [Accepted: 12/19/2014] [Indexed: 06/04/2023]
Abstract
This study was designed to determine the feasibility and accuracy of a sonographic approach to assessment of facet joints of the lumbar spine in healthy populations. Five facet joints (L1-S1) on each side of 30 volunteers, for a total of 300 facet joints, were examined and evaluated by sonography and computed tomography. Parameters of the facet joints (height and width) were established to assess the facet joint in the parasagittal and transverse planes on all volunteers. Differences between means of continuous variables including age, height, weight, body surface area, body mass index and joint parameters were evaluated with Student's t-test. Stepwise multiple regression analysis was used to evaluate the associations between the mean values of facet joint parameters and age, height, body surface area and body mass index. In general, sonography revealed that facet joints had a clear and smooth border. There were no significant differences in width and height between the left and right facet joints at the same level by sonography. Stepwise multiple regression analysis revealed that body mass index and age (p < 0.05) were the only independent factors modulating height of the facet joint. Facet joint width was independently influenced by age (p < 0.01). There were no significant differences between ultrasound and computed tomography in mean measurements of height (1.23 ± 0.15 vs. 1.25 ± 0.07, p > 0.05) and width (0.17 ± 0.08 vs. 0.18 ± 0.07, p > 0.05) of the facet joint, respectively. In this article, we describe a feasible, accurate and simple technique for identification and depiction of facet joints of the lumbar spine in healthy populations.
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Affiliation(s)
- Da Liu
- Department of Orthopaedic Surgery, Shengjing Hospital of China Medical University, Shenyang, China
| | - Ying Huang
- Department of Ultrasound, Shengjing Hospital of China Medical University, Shenyang, China.
| | - Dan Tian
- Department of Ultrasound, Shengjing Hospital of China Medical University, Shenyang, China
| | - Jing Yin
- Department of Ultrasound, Shengjing Hospital of China Medical University, Shenyang, China
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Gossner J. Safety of CT-Guided Lumbar Nerve Root Infiltrations. Analysis of a Two-Year Period. Interv Neuroradiol 2014; 20:533-7. [PMID: 25363255 DOI: 10.15274/inr-2014-10082] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2014] [Accepted: 04/25/2014] [Indexed: 11/12/2022] Open
Abstract
Selective nerve root infiltrations are frequently performed in patients with lumbar radiculopathy. Computed tomography (CT) is now commonly used for image guidance. Despite the widespread use of CT-guided lumbar nerve root infiltrations few studies have systematically examined the safety of this approach. In a two-year period, 231 lumbar nerve root infiltrations were performed on in-patients and were retrospectively reviewed. No major complications like inflammation (especially spondylodiscitis), large haematomas requiring surgery, severe allergic reactions or spinal ischaemia occurred. In accordance with other published studies, CT-guided lumbar nerve root infiltrations seem to be safe. To minimize the risk of catastrophic neurological complications due to spinal ischaemia, careful needle placement dorsal to the nerve root and the use of a non-particulate corticosteroid, like dexamethasone, are advocated.
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Affiliation(s)
- Johannes Gossner
- Department of Clinical Radiology, Evangelisches Krankenhaus Göttingen-Weende; Göttingen, Germany -
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Kim YH, Park HJ, Moon DE. Ultrasound-guided Pararadicular Injection in the Lumbar Spine: A Comparative Study of the Paramedian Sagittal and Paramedian Sagittal Oblique Approaches. Pain Pract 2014; 15:693-700. [DOI: 10.1111/papr.12249] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2014] [Revised: 05/07/2014] [Accepted: 07/13/2014] [Indexed: 11/26/2022]
Affiliation(s)
- Young Hoon Kim
- Department of Anesthesiology and Pain Medicine; College of Medicine; Seoul St. Mary's Hospital; The Catholic University of Korea; Seoul Korea
| | - Hue Jung Park
- Department of Anesthesiology and Pain Medicine; College of Medicine; Seoul St. Mary's Hospital; The Catholic University of Korea; Seoul Korea
| | - Dong Eon Moon
- Department of Anesthesiology and Pain Medicine; College of Medicine; Seoul St. Mary's Hospital; The Catholic University of Korea; Seoul Korea
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Ultrasonography of the lumbar spine: sonoanatomy and practical applications. Joint Bone Spine 2014; 81:130-6. [PMID: 24618457 DOI: 10.1016/j.jbspin.2013.10.009] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/23/2013] [Indexed: 12/12/2022]
Abstract
Ultrasonography of the bones and joints has gained considerable ground in the field of rheumatology over the past decade and is now used in everyday practice both for diagnostic purposes and to guide local injections. However, the use of ultrasonography is virtually confined to the peripheral joints, whereas spinal diseases make a major contribution to rheumatology practice. Studies have established that ultrasonography of the lumbar spine is feasible. Adequate equipment and familiarity with spinal sonoanatomy are required. In this update, we suggest starting with a systematic examination of the lumbar spine to assess the various anatomic structures, from the thoracolumbar fascia superficially to the posterior part of the vertebras at the deepest level. The ligaments, erector spinae muscles, facet joints, and transverse processes can be visualized. Ultrasonography can serve to guide injections into the facet joints, about the nerve roots, and into the iliolumbar ligaments; as well as to identify relevant landmarks before epidural injection. Although diagnostic applications are more limited at present, systematic studies of abnormal ultrasonography findings will allow evaluations of the potential usefulness of ultrasonography for diagnosing spinal disorders. The depth of the spinal structures limits the ability to obtain high-resolution images. However, future technical improvements in ultrasound transducers and machines, together with the growing number of physicians trained in ultrasonography, can be expected to benefit the development of spinal ultrasonography in the near future.
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Gossner J. Safety of CT-Guided Lumbar Nerve Root Infiltrations. Neuroradiol J 2014. [DOI: 10.15274/nrj-2014-10053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Affiliation(s)
- Young Hoon Kim
- Department of Anesthesiology and Pain Medicine, Seoul St. Mary's Hospital, The Catholic University of Korea School of Medicine, Seoul, Korea
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Ultrasound-guided versus computed tomography-controlled periradicular injections in the middle and lower cervical spine: a prospective randomized clinical trial. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2013; 22:2532-7. [PMID: 23877110 DOI: 10.1007/s00586-013-2916-0] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/24/2013] [Revised: 06/11/2013] [Accepted: 07/12/2013] [Indexed: 12/26/2022]
Abstract
PURPOSE 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.
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Ungi T, Abolmaesumi P, Jalal R, Welch M, Ayukawa I, Nagpal S, Lasso A, Jaeger M, Borschneck DP, Fichtinger G, Mousavi P. Spinal Needle Navigation by Tracked Ultrasound Snapshots. IEEE Trans Biomed Eng 2012; 59:2766-72. [DOI: 10.1109/tbme.2012.2209881] [Citation(s) in RCA: 50] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
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