Ultrasound-guided costovertebral joint injection-technique description and fluoroscopy and computerized tomography combined controlled cadaveric feasibility study.

Autor:	Ferreira-Silva N; Department of Physical Medicine and Rehabilitation, Hospital Professor Doutor Fernando Fonseca, 2720-276 Amadora, Portugal., Worthy L; Washington and Lee University, Lexington, VA 24450, United States., Ribas R; Department of Anesthesiology, Centro Hospitalar Universitário de Lisboa Norte, 1649-028 Lisboa, Portugal., Ferreira-Dos-Santos G; Division of Pain Medicine, Department of Anesthesiology, Reanimation, and Pain Medicine, Hospital Clínic de Barcelona, Barcelona, 08036 Catalonia, Spain., Bestic J; Department of Radiology, Mayo Clinic, Jacksonville, FL 32224, United States., Hurdle MFB; Department of Pain Medicine, Mayo Clinic, Jacksonville, FL 32224, United States.
Jazyk:	angličtina
Zdroj:	Pain medicine (Malden, Mass.) [Pain Med] 2024 Jan 04; Vol. 25 (1), pp. 8-12.
DOI:	10.1093/pm/pnad123
Abstrakt:	Objectives: To describe and assess the feasibility of an ultrasound-guided technique for intra-articular injection of the costovertebral joints, in an unembalmed cadaveric specimen, utilizing fluoroscopy and cone beam computerized tomography for confirmation of contrast spread and needle tip position, respectively. Methodology: A single unembalmed cadaveric specimen was obtained. A single interventionist performed the placement of the needles under ultrasound guidance. Contrast dye was then injected through each of the needles under real-time fluoroscopy. Finally, the specimen was submitted to a cone beam computerized tomography with 3-dimensional acquisition and multiplanar reformatting to assess final needle tip position relative to the costovertebral joints. Results: In total, 18 spinal needles were placed under ultrasound guidance. Fluoroscopy showed 4 distinct patterns of contrast spread: intra-articular in the costovertebral joint (13 levels in total), epidural (1 level), intra-articular in the facet joint of the target level (3 levels), and undetermined (1 level). Cone-beam computerized tomography confirmed 13 out of 18 needles to be adequately placed in the costovertebral joints (72% of the total) and 5 out of the 18 needles to be misplaced: 3 needles were placed in the facet joint of the target level, and 2 needles were placed in the epidural space. Conclusions: This study suggests that, when performed by experienced interventionists, this technique has an accuracy rate of 72%. Further studies are warranted before these results can be extrapolated to daily clinical practice. (© The Author(s) 2023. Published by Oxford University Press on behalf of the American Academy of Pain Medicine. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.)
Databáze:	MEDLINE
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