PAIN+ CPN

BACKGROUND: Ultrasound-guided transforaminal (USF) injections have been proposed as a faster and more easily accessible alternative to traditional radioscopic methods for cervical radicular pain, but their efficacy and safety in cervical spine interventions remain uncertain.

METHODS: Pubmed, Embase, and Cochrane Library were searched for studies comparing ultrasound (US)-guided cervical transforaminal injections versus traditional radioscopic methods of epidural injection for patients 1104. We computed standardized mean differences (SMD) for continuous pain outcomes, mean differences (MD) for neck disability index (NDI) and time procedure, odds ratios (OR) for binary outcomes, with 95% confidence intervals (CI).

RESULTS: We included 7 studies, comprising 1104 patients. USF technique was used in 537 patients (48.6%). Pain and disability outcomes were comparable between groups, respectively (SMD = 0.15; 95% CI, -0.01 to 0.31; P = 0.04; I2 = 21%) and (MD = 0.56; 95% CI, -0.28 to 1.39; P = .03; I2 = 0%). US guidance significantly reduced vascular injection risk (OR = 0.13; 95% CI, 0.07-0.25; P < .00001; I2 = 0%) and reduced the procedure time (MD = -158; 95% CI, -228 to -90; P < .00001; I2 = 70%).

CONCLUSIONS: In 537 patients with cervical radicular pain, USF techniques were associated with a lower incidence of intravascular injection and a shorter procedure time compared with radioscopic-guided methods, while no significant differences were observed in pain or NDI outcomes.

Physician rater

The authors performed a systematic review comparing ultrasound and radioscopic guidance for epidural cervical steroid injection. There was no difference in the success of the procedure. Ultrasound had a lower intravascular injection and allowed the procedure to be accomplished faster. Since this article is a meta-analysis, pain physicians may already know this information; those not as familiar with pain medicine will most likely not know this information.

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