• A Loizides, H Gruber, S Peer, K Galiano, R Bale, and J Obernauer.
• Department of Radiology, Innstruck Medical University, 6020 Innsbruck, Austria. alexander.loizides@i-med.ac.at
• AJNR Am J Neuroradiol. 2013 Feb 1;34(2):466-70.

Background And PurposeInjection therapies play a major role in the treatment of lower back pain and are to date performed mainly under CT- or fluoroscopic guidance. We conducted this study to evaluate the accuracy, time savings, radiation doses, and pain relief of US-guided pararadicular injections versus CT-controlled interventions in the lumbar spine in a prospective randomized clinical trial.Materials And MethodsForty adult patients were consecutively enrolled and assigned to a US or CT group. US-guided pararadicular injections were performed on a standard US device by using a broadband curved-array transducer (9-4 or 5-1 MHz). In the in-plane technique, the needle was advanced through the respective segmental intertransverse ligament. The needle tip position was verified by CT. The CT-guided approaches were performed under standardized procedures by using the CT-positioning laser function.ResultsThe accuracy of US-guided interventions was 90%. The mean time to final needle placement in the US group was 4.0 ± 1.8 minutes, and in the CT group, 7.6 ± 2.1 minutes. The mean radiation doses, including CT confirmation for study purposes only, were 20.3 ± 9.0 mGy cm for the US group and 42.6 ± 36.1 mGy cm for the CT group. Both groups showed the same significant pain relief (P < .05) without relevant "intermethodic" differences of pain relief (P > .05).ConclusionsUS-guided pararadicular injections show a therapeutic effect similar to that in the time-consuming, expensive, ionizing CT or fluoroscopically guided pararadicular injections and result in a significant reduction of procedure time expenditure and avoidance of radiation.

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