gms | German Medical Science

Objective: Cervical radicular pain is a disabling condition, which affects approximately 0.1% of the population. Cervical selective nerve root block (CSNRB) is a well-established, minimally invasive procedure to treat radicular cervical pain, when medical therapy is exhausted. Nowadays these blocks are often performed under fluoroscopy or CT-guided. However, the procedure is technically challenging and can lead to major complications. The objective of this study was to evaluate the feasibility of a three-dimensional puncture planning and two-dimensional laser guidance system for CSNRB in a lamb model.

Method: Dyna-CT of the cervical spine of an ex-vivo lamb model was performed with the Artis Zee^® Ceiling (Siemens Medical Solutions, Erlangen, Germany) to acquire multiplanar reconstruction images. 15 cervical nerve root punctures were planned and conducted with the Syngo iGuide^® laser guidance system. Correct location of needle tip and distribution of contrast dye was analyzed by two independent investigators. Procedural, planning, and fluoroscopic time, tract length and dose area product (DAP) were acquired for each puncture.

Results: All 15 punctures were rated as successful with 12 punctures on the first attempt. Total procedural time was approximately 5 minutes. Median planning time for the puncture was 2.05 (± 0.65) min. Median puncture time was 2.27 (± 0.53) min, while median time fluoroscopy time was 0.28 (± 0.10) min. Median tract length was 2.68 (± 0.23) cm. Median total DAP was 397.45 (± 15.63) μGy m².

Conclusions: CSNRB performed with Dyna-CT and the tested Syngo iGuide^® laser guiding system is a feasible technique in an ex-vivo lamb model. 3D pre-puncture planning is extremely easy and fast and the laser guiding system ensures very accurate and intuitive puncture control. Therefor the technique seems safe to be further studied in clinical trials.