Open AccessComputer-Tomographic Verification of Ultrasound-Guided Piriformis Muscle Injection: A Feasibility Study
Author(s) -
Gustavo Fabregat-Cid
Publication year - 2014
Publication title -
pain physician
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.31
H-Index - 99
eISSN - 2150-1149
pISSN - 1533-3159
DOI - 10.36076/ppj.2014/17/507
Subject(s) - medicine , piriformis syndrome , magnetic resonance imaging , lumbar , radiology , fluoroscopy , ultrasound , iodinated contrast , low back pain , nuclear medicine , sciatica , computed tomography , pathology , alternative medicine
Background: Approximately 6% to 8% of lumbar pain cases, whether associated withradicular pain or not, may be attributed to the presence of piriformis muscle syndrome.Available treatments, among others, include pharmacotherapy, physical therapy, and injectionsof different substances into the muscle. Various methods have been used to confirm correctneedle placement during these procedures, including electromyography (EMG), fluoroscopy,computed tomography (CT), or magnetic resonance imaging (MRI). Ultrasonography (US) hasnow become a widely used technique and therefore may be an attractive alternative forneedle guidance when injecting this muscle.Objective: The objective of this study was to assess the reliability of US in piriformis injectionof patients with piriformis syndrome.Study Design: Feasibility study; 10 patients with piriformis muscle syndrome were injectedwith botulinum toxin A using a US-guided procedure. Then patients were administered 2 mLiodinated contrast and were then transferred to the CT scanner, where they underwent pelvicand hip imaging to assess intramuscular distribution of the iodinated contrast.Setting: Multidisciplinary Pain Management Department in Spain.Results: Of all 10 study patients (8 women, 2 men), 9 had intramuscular or intrafascialcontrast distribution. Distribution did not go deeper than the piriformis muscle in any of thepatients. The absence of contrast (intravascular injection) was not observed in any case.Limitations: The main limitation of our study is the use of ionizing radiation as confirmationtechnique.Conclusion: Ultrasound-guided puncture may be a reliable and simple procedure forinjection of the piriformis muscle, as long as good education and training are provided to theoperator. US has a number of advantages over traditional approaches, including accessibilityand especially no ionizing radiation exposure for both health care providers and patients.Key words: Piriformis, ultrasound-guidance, CT, pain, chronic pain, ultrasonography,botulinum toxin, sciatica