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 18 spinal needles were placed under ultrasound guidance. Fluoroscopy showed four 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.

中文翻译：

---

超声引导肋椎关节注射——技术描述以及透视和计算机断层扫描联合受控尸体可行性研究


目的 描述和评估超声引导技术在未防腐尸体标本中进行肋椎关节关节内注射的可行性，利用荧光镜和锥形束计算机断层扫描分别确认造影剂扩散和针尖位置。方法学 获得单一未防腐尸体标本。一名介入医生在超声引导下进行了针的放置。然后在实时荧光透视下通过每根针注射对比染料。最后，将标本进行锥形束计算机断层扫描，进行 3 维采集和多平面重新格式化，以评估相对于肋椎关节的最终针尖位置。结果 18 根脊椎穿刺针在超声引导下放置。透视显示四种不同的造影剂扩散模式：肋椎关节的关节内（总共 13 个级别）、硬膜外（1 个级别）、目标级别的小关节的关节内（3 个级别）和未确定的（1 个级别） 。锥形束计算机断层扫描证实 18 根针中的 13 根充分放置在肋椎关节中（占总数的 72%），18 根针中的 5 根错位：3 根针放置在目标平面的小关节中，硬膜外腔内放置 2 根针。结论 这项研究表明，当由经验丰富的干预医生执行时，该技术的准确率为 72%。在将这些结果外推到日常临床实践之前，需要进行进一步的研究。