Ultrasound (US) guidance in facet joint injections has been reported previously as an alternative to imaging modalities with ionizing radiation. However, this technique has not been adopted in the clinical routine, due to difficulties in the visualization of the target joint in US and simultaneous manipulation of the needle. Methods: We propose a technique to increase targeting accuracy and efficiency in facet joint injections. This is achieved by electromagnetically tracking the positions of the US transducer and the needle, and recording tracked US snapshots (TUSS). The needle is navigated using the acquired US snapshots. Results: In cadaveric lamb model, the success rate of facet joint injections by five orthopedic surgery residents significantly increased from 44.4% (p<0.05) with freehand US guidance to 93.3% with TUSS guidance. Needle insertion time significantly decreased from 47.9 ± 34.2 s to 36.1 ± 28.7 s (mean ± SD). In a synthetic human spine model, a success rate of 96.7% was achieved with TUSS. The targeting accuracy of the presented system in a gel phantom was 1.03 ± 0.48 mm (mean ± SD). Conclusions: Needle guidance with TUSS improves the success rate and time efficiency in spinal facet joint injections. This technique readily translates also to other spinal needle placement applications.
Ungi T, Abolmaesumi P, Jalal R, Welch M, Ayukawa I, Nagpal S, Lasso A, Jaeger M, Borschneck DP, Fichtinger G, Mousavi P. Spinal needle navigation by tracked ultrasound snapshots. IEEE Trans Biomed Eng. 2012 Oct;59(10):2766-72.