Ultrasound-Guided Versus Conventional Fluoroscopy-Guided Epidural Injection for Radiculopathy. A Meta-Analysis of Randomized Controlled Trials

Abstract

Background: Radiculopathy, a painful condition due to the irritation of a spinal nerve root, is a common neurosurgical presentation. Apart from its conventional treatment with pain killers and surgical management, it can also be managed with epidural steroid injections (ESIs). The objective of this study is to compare ultrasonography (USG) guidance with conventional fluoroscopy (FL) guidance for ESIs to treat radiculopathy.

Methods: PubMed, Embase, Clinicaltrials.gov, and Cochrane were systematically searched and randomized controlled trials comparing USG with conventional FL for ESIs in the case of radiculopathy were included. Web Revman was used for data analysis.

Results: The Literature search resulted in 640 studies, of which 7 studies were included in this meta-analysis after extensive screening. There was no statistically significant difference in pain reduction between USG and FL groups especially in the case of lumbosacral spinal level at 1 month [mean difference -0.12 (-0.47-0.23)] and at 3 months [mean difference 0.73 (-1.49, 2.96)]. Similarly, functional improvement after ESIs was comparable between the 2 groups. The Risk of inadvertent vascular puncture in USG-guided ESIs was lower as compared to conventional FL-guided ESIs [odds ratio 0.21 (0.07, 0.64)]. Furthermore, the procedure time in the USG group was also significantly lower as compared to FL group.

Conclusion: USG-guided ESIs are not only comparable to conventional FL-guided ESIs in terms of pain control and functional improvement, particularly evident at the lumbosacral spinal level, but also have a lower risk of inadvertent vascular puncture.

Keywords: Epidural steroid injection; Fluoroscopy; Radiculopathy; Ultrasonography.