Ultrasound-Guided Cervical Periradicular Steroid Injection for Cervical Radicular Pain: Relevance of Spread Pattern and Degree of Penetration of Contrast Medium
Bibliographic record
Abstract
BACKGROUND AND OBJECTIVES: Ultrasound-guided cervical periradicular steroid injection (US-CPSI) is an attractive alternate to conventional C-arm guided transforaminal epidural injection for treatment of cervical radicular pain. We compared the technical differences and clinical outcomes between these two techniques. METHODS: Following ultrasound-guided needle placement, the extent of contrast media spread and the degree of tissue penetration were monitored by real-time fluoroscopy at the time of cervical periradicular injection in 59 patients. The spread pattern was judged to be medial foramen (medial bisector of foramen), lateral foramen (lateral bisector of foramen), or extraforaminal. The degree of tissue penetration was classified into periradicular, pararadicular, and intramuscular based on the penetration characteristics. Ultrasonographic images were categorized into crescent, perineuronal protruding, and intramuscular types. These groups were then correlated with clinical outcomes. RESULTS: The actual distance between the ultrasound-guided needle position and fluoroscopic target point was 1.9 and 2.3 cm in the oblique and anteroposterior view, respectively. Despite a difference in ultrasound and fluoroscopic end points, contrast dye spread was found to reach lateral foramen in 53%, medial foramen in 34%, and extraforaminal in 13% of the subjects. Analysis of postprocedural pain reduction (PPPR) showed significantly the better outcomes in periradicular and pararadicular penetration, medial and lateral, and crescent and perineural protruding type without subgroup differences than intramuscular penetration, extraforaminal spread, and ultrasonographic images of intramuscular type (P < 0.001). Analysis of clinical overall outcome showed favorable outcome in the groups with better results of PPPR. CONCLUSION: Our preliminary data suggest that the technique of UP-CPSI can provide an adequate local spread pattern, tissue penetration for treatment of cervical radicular pain.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.000 | 0.003 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.000 | 0.000 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.001 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".