Ultrasound versus fluoroscopic-guided epidural steroid injections in patients with degenerative spinal diseases A randomised study

BACKGROUND Epidural steroid injections are routinely performed under fluoroscopic guidance, but could also be performed using preprocedure ultrasound spine examination. OBJECTIVES To compare ultrasound-assisted and fluoroscopy-controlled epidural steroid injections with regard to technical feasibility (accuracy, average procedure time) and outcome (pain relief and degree of disability score). DESIGN A randomised study. SETTING University hospital between January 2010 and September 2012. PATIENTS One hundred and twelve patients with axial chronic lower back and extremity pain diagnosed with degenerative diseases of the spine, receiving three lumbar interlaminar epidural steroid injections, were randomly assigned between two groups. INTERVENTION In the fluoroscopic group, injections were performed under fluoroscopic guidance, and in the ultrasound group, ultrasound scanning of the lumbar spine was performed before the injection to determine the puncture site, depth of the epidural space and needle trajectory. MAIN OUTCOME MEASURES Procedure time, numbers of needle insertion attempts and needle passes, visual analogue scale for pain and Oswestry disability index at 1 and 3 months posttreatment. RESULTS There was no significant difference between the two groups in mean procedure time, number of needle insertion attempts or needle passes. The mean pain intensity and degree of disability scores before the procedure, and at 1 and 3 months postprocedure, were similar in the two groups. Neither group had serious complications. CONCLUSION We have demonstrated the feasibility of ultrasound-assisted epidural steroid injections.