Article Text

Download PDFPDF
Ultrasound-Guided Periradicular Injections in the Middle to Lower Cervical Spine: An Imaging Study of a New Approach
  1. Klaus Galiano, M.D.,
  2. Alois Albert Obwegeser, M.D., M.S.,
  3. Gerd Bodner, M.D.,
  4. Martin Cornelius Freund, M.D.,
  5. Hannes Gruber, M.D.,
  6. Herbert Maurer, M.D.,
  7. Reinhold Schatzer, M.S. and
  8. Franz Ploner, M.D.
  1. From the Clinic of Neurosurgery(K.G., A.A.O.) and Radiology(G.B., M.C.F., H.G.), and the Institute of Anatomy and Histology (H.M.), Medical University of Innsbruck, Innsbruck, Austria
  2. RTI International(R.S.), Durham, NC
  3. Department of Anesthesiology and Pain Care (F.P.), Hospital of Vipiteno, Vipiteno, Italy
  1. Reprint requests: Alois Albert Obwegeser, M.D., M.S., Clinic of Neurosurgery, Medical University of Innsbruck, Anichstrasse 35, 6020 Innsbruck, Austria. E-mail: alois.obwegeser{at}


Background and Objectives The objective of this study was to show the efficacy of ultrasound in facilitating the performance of a simulated cervical periradicular injection in cadavers.

Methods A total of 40 ultrasound-guided examinations at 4 levels (C3 to C7) were performed on 4 embalmed cadavers. The cervical spinal nerves were located with ultrasound. First, the transverse process of each level was taken as a sonoanatomic landmark. The most lateral aspect of the transverse process of the seventh cervical vertebra was then established as the reference point. Ipsilateral distances (A, B, C, and D) between this point and each one of the transverse processes of the cervical spine up to the third vertebra were then computed. Subsequently, coronal computed tomography (CT) scans were taken to verify these distances. In a second part, a spinal needle was advanced under ultrasound guidance to the spinal nerves C5 to C8 on both sides of one cadaver. The exact placement of the needle tips was checked by CT.

Results The transverse processes were identified in all cadavers. In 5 attempts, a depiction of the spinal nerves was not possible. Ultrasound and CT provided the same mean measurements of 1.1 cm, 2.1 cm, 3.1 cm, and 4.1 cm for distances A, B, C, and D, respectively. All 8 needle tips were placed within 5 mm dorsal to the spinal nerve and less than 5 mm away from the posterior tubercle of each level's transverse process, as also verified by CT.

Conclusions This preclinical study suggests that ultrasound is a useful guiding tool for periradicular injections in the cervical spine.

  • Cervical spine
  • Feasibility
  • Periradicular injection
  • Ultrasound

Statistics from

Request Permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.