Ultrasound-guided versus computed tomography-controlled periradicular injections of the first sacral nerve: a prospective randomized clinical trial

Abstract

Aim: To compare ultrasound (US)-guided versus computed tomography (CT)-controlled periradicular injections of the first sacral spinal (S1) nerve in a prospective randomized clinical trial.

Materials and methods: Thirty-nine patients with S1-radiculopathy were consecutively enrolled for 40 periradicular injections and assigned to an US or CT guided group. Needle position after US-assisted placement was controlled by a low-dose CT-scan. Accessibility, accuracy, and intervention time were compared. The overall effect on pain was matched evaluating the visual analog scale (VAS) decrease before and one month after the intervention.

Results: The mean intervention time was lower in the US-group compared to the CT-group: 4.4±3.46 min (1.3-13.2) vs. 6.5±3.03 min (2.4-12.5). Using CT-controlled infiltration the mean number of needle passes was with 1.15 higher than utilizing US-guidance. The therapeutic effect (mean difference between pre- and post-intervention, VAS scores) for the CT-group was 4.85±2.52 and for the US-group 4.55±2.74 with no significant difference between the two groups (p=0.7).

Conclusion: US-controlled infiltrations of the first sacral nerve show a similar therapeutic effect to the time consuming, and ionizing CT-controlled injections and result in a significant reduction of procedure expenditure and avoidance of radiation.