Fluoroscopic C-Arm Guided versus Ultrasound Guided Therapeutic Injection of Lower Cervical Radiculopathies

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Abstract Background Chronic pain imposes significant impact on individuals and the health system as it is often accompanied by significant physical, emotional and social burden. It is frequently associated with anxiety disorders, depression, substance abuse disorders and post-traumatic stress disorder. Severe chronic pain is also associated with increased risk of morbidity and mortality. Objective To compare the therapeutic efficacy and safety of ultrasound-guided selective cervical intra-tubercular nerve root block versus fluoroscopic guided cervical interlaminar epidural block on cervical nerve roots in lower cervical radiculopathies through assessment of pain relief and functional improvement. Patients and Methods: This study was conducted on 60 patients with lower cervical radiculopathies confirmed by cervical MRI, not responding to conventional medical treatment. These patients were randomly allocated to receive cervical injection guided by either ultrasonography or C-arm Fluoroscopy. Patients were initially assessed and followed up at 1 week, 2 weeks, 3 months, 6 months, and 12 months by Visual Analog Scale, Mankoski Pain Scale and Brief Pain Inventory Scale. Results In the present study both groups showed significant improvement from baseline till 3 months post injection regarding pain and functional scales. However, in fluoroscopic group the improvement continued till 6 months and 12 months versus patients in ultrasound group. Conclusion Ultrasound-guided selective cervical intra-tubercular nerve root block and fluoroscopic-guided cervical intra-laminal epidural injection showed the same response in lower cervical radicular pain at 3 months with better outcome in fluoroscopic group at 6 months and 12 months.

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