الفهرس 
IntroductionOnly 14 pages are availabe for public view
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Abstract
Purpose of this study: to evaluate the efficacy of ultrasound-guided selective lumbar nerve root steroid injection comparing it to fluoroscopy guided injections for the treatment of lumbar radicular pain in terms of pain relief, clinical improvement, analgesic requirement, complications, operative time and accuracy of needle positioning.
Methods: 74 patients aging from 18 to 60 years old with unilateral lumbar radicular pain due to disc prolapse undergoing selective lumbar nerve root injection were divided into ultrasound group (US) and fluoroscopy group (FL). SNRI was done to inject the affected nerve roots under ultrasound guidance or fluoroscopy guidance. We assessed Visual analogue scale (VAS) and Oswestry disability index (ODI) and analgesic requirement for all patients before the injection, at one week, two weeks, one month, two months and three months after the injection. We recorded the complications during and after the procedure. We also recorded the Accuracy of needle insertion in group US using fluoroscopy confirmation and the duration of the operative time in both groups.
Results: VAS scores, ODI and analgesic requirements were significantly lowered in both groups when compared to baseline, and there was no significant difference between the two groups. Also, no major complications were recorded in both groups. Needle positioning using ultrasound was accurate in 91.9% of the patients in group US when confirmed using fluoroscopy. The operative time in the ultrasound group (414.8± 49.1s) showed significant reduction compared to the operative time in the fluoroscopy group (552.2±44.5s).
Discussion: ultrasound-guided selective lumbar nerve root injection is as effective as fluoroscopy in terms of pain management, more convenient and more easily available option while being safer in terms of radiation exposure and low complications rate. Ultrasound showed good accuracy when used to guide needle insertion. Also, it showed reduction of the operative duration when compared to fluoroscopy helping the patients be more comfortable and more compliant in the operative room with the increased speed of turnover.
Conclusion: Ultrasound-guided selective lumbar nerve root injection showed good efficacy compared to fluoroscopy guided injection in treatment of lumbar radicular pain caused by lumbar disc prolapse, as it showed no significant difference in pain control, clinical improvement and in the need for analgesia. Also, there was no significant increase in complications rate with the reduction in radiation exposure affecting the patients and the medical care providers. Also, there was reduction in the operative time in the ultrasound group with good accuracy in needle positioning when using ultrasound alone.
Conclusion
Ultrasound-guided selective lumbar nerve root injection is as efficient as fluoroscopy guided injection in treatment of lumbar radicular pain caused by lumbar disc prolapse, as it showed no significant difference in pain control, clinical improvement and in the need for analgesia. Also, there was no significant increase in complications rate with the reduction in radiation exposure affecting the patients and the medical care providers. Also, there was reduction in the operative time in the ultrasound group with good accuracy in needle positioning when using ultrasound alone.