Therapeutics
Kevin R. Murray, MD
Resident Physician
University of Toronto
Toronto, Ontario, Canada
Emily T. Domerchie, MD
Resident Physician
University of Toronto
Toronto, Ontario, Canada
Michael Catapano, MD
Physician
University of Toronto
Toronto, Ontario, Canada
Cervical radiculopathy is a common cause of neck and upper extremity pain, with a prevalence of up to 6 percent. While most patients will improve spontaneously within the first year, radicular pain can be debilitating and impact physical function. Thus, interventional treatments to control pain are an important component of radiculopathy management. Spinal injections have traditionally been performed using fluoroscopic or computed tomography guidance; however, ultrasound guidance has emerged as a potentially safer and more accessible alternative. We sought to systematically assess the efficacy and safety of ultrasound guidance as compared to fluoroscopic or computed tomography guidance for cervical spinal nerve injection.
Design: Systematic review and meta-analysis.
Results:
We searched Medline, Embase, PubMed, and Scopus for relevant articles. Our primary outcome was visual analog or numeric rating scale for pain, and our secondary outcomes were procedure time and adverse events. Our search returned 2208 unique results, from which 5 randomized control trials and 11 observational studies were included. There was no difference in pain between ultrasound guidance and fluoroscopic or computed tomography guidance at 1-month (standard mean difference: 0.04 (95% confidence interval: -0.11, 0.18); P=0.63), 3-months (0.09 (-0.04, 0.22); P=0.17), or 6-months (0.08 (-0.12, 0.27); P=0.45). Ultrasound guidance resulted in a significantly shorter procedure time (-1.76 (-1.93, -1.58); P< 0.001) and a lower intravascular injection rate (odds ratio: 0.10 (95% confidence interval: 0.04, 0.23); P< 0.001) compared with fluoroscopic or computed tomography guidance.
Conclusion: In the treatment of cervical radiculopathy, ultrasound guidance is similarly effective, but with a faster procedure time and lower complication rate compared to traditional guidance techniques.
