Ultrasound- Versus Fluoroscopy-guided Injections in the Lower Back for the Management of Pain: a Systematic Review

Overview

Journal Eur Radiol

Specialty Radiology

Date 2019 Mar 20

PMID 30887198

Citations 5

Authors

Mark Hofmeister

Laura E Dowsett

Diane L Lorenzetti

Fiona Clement

Affiliations

Soon will be listed here.

Abstract

Purpose: Ultrasound-guided spinal injections are less common than fluoroscopy-guided injections. Although unable to penetrate bones, ultrasound guidance has a number of advantages including convenience and reduced exposure to ionizing radiation. However, it is not known how ultrasound-guided injections compare to fluoroscopy-guided injections in the management of lower back pain. Our objective is to systematically review the literature comparing ultrasound-guided injections to fluoroscopy-guided injections for the management of lower back pain.

Methods: Medline, Cochrane CENTRAL Register of Controlled Trials, Embase, and NHSEED were searched from 2007 to September 26, 2017. Inclusion criteria included (1) randomized controlled trial design, (2) compared ultrasound-guided and fluoroscopy-guided injections for lower back pain, (3) dose and volume of medications injected were identical between trial arms, and (4) reported original data.

Results: One hundred one unique records were identified, and 21 studies were considered for full-text inclusion. Nine studies formed the final data set. Studies comparing ultrasound- and fluoroscopy-guided injections for lower back pain management reported no difference in pain relief, procedure time, number of needle passes, changes in disability indices, complications or adverse events, post-procedure opioid consumption, or patient satisfaction.

Conclusion: Fluoroscopic guidance of injections for the management of lower back pain is similar in efficacy to ultrasound guidance. The exact role of ultrasound guidance needs to be further studied, especially for nerve root injections, where safety is the major concern.

Key Points: • There were no differences in pain relief, procedure time, number of needle passes, changes in disability indices, complications or adverse events, post-procedure opioid consumption, or patient satisfaction between ultrasound- and fluoroscopy-guided injections for the management of lower back pain. • Given the lack of evidence to demonstrate superior efficacy and the added harms with fluoroscopic guidance, ultrasound guidance may be the preferred method of guidance for injections to manage lower back pain in appropriate patients. Further study is required to understand the exact role of ultrasound in image-guided injections.

Citing Articles

Ultrasound-Guided vs. Fluoroscopy-Guided Interventions for Back Pain Management: A Systematic Review and Meta-Analysis of Randomized Controlled Trials.

Viderman D, Aubakirova M, Aryngazin A, Yessimova D, Kaldybayev D, Tankacheyev R Diagnostics (Basel). 2023; 13(22).

PMID: 37998610 PMC: 10670286. DOI: 10.3390/diagnostics13223474.

Fluoroscopy-Guided Versus Fluoroscopy-Confirmed Ultrasound-Guided S1 Transforaminal Epidural Injection with Pulsed Radiofrequency: A Prospective, Randomized Trial.

Guven Kose S, Kose H, Celikel F, Akkaya O Eurasian J Med. 2023; 55(1):43-49.

PMID: 36861865 PMC: 10081137. DOI: 10.5152/eurasianjmed.2023.22265.

An MR-Conditional Needle Driver for Robot-Assisted Spinal Injections: Design Modifications and Evaluations.

Wang Y, Liu G, Li G, Cleary K, Iordachita I Annu Int Conf IEEE Eng Med Biol Soc. 2022; 2022:3307-3312.

PMID: 36086159 PMC: 9490797. DOI: 10.1109/EMBC48229.2022.9871596.

Ultrasound-guided lumbar medial branch blocks and intra-articular facet joint injections: a systematic review and meta-analysis.

Ashmore Z, Bies M, Meiling J, Moman R, Hassett L, Hunt C Pain Rep. 2022; 7(3):e1008.

PMID: 35620250 PMC: 9113209. DOI: 10.1097/PR9.0000000000001008.

Ultrasound-Guided Lumbar Spine Injection for Axial and Radicular Pain: A Single Institution Early Experience.

Tay M, Sian S, Eow C, Ho K, Ong J, Sirisena D Asian Spine J. 2020; 15(2):216-223.

PMID: 32872762 PMC: 8055452. DOI: 10.31616/asj.2019.0399.

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