Laser-Guided Cervical Selective Nerve Root Block with the Dyna-CT: Initial Experience of Three-Dimensional Puncture Planning with an Ex-Vivo Model

Background: Cervical selective nerve root block (CSNRB) is a well-established, minimally invasive procedure to treat radicular cervical pain. However, the procedure is technically challenging and might 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 an ex-vivo model. Methods: Dyna-CT of the cervical spine of an ex-vivo lamb model was performed with the Artis Zee(R) Ceiling (Siemens Medical Solutions, Erlangen, Germany) to acquire multiplanar reconstruction images. 15 cervical nerve root punctures were planned and conducted with the syngo iGuide(R) laser-guidance system. Needle tip location and contrast dye distribution were 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. Mean planning time for the puncture was 2.03 (+/-0.39) min. Mean puncture time was 2.16 (+/-0.32) min, while mean fluoroscopy time was 0.17 (+/-0.06) min. Mean tract length was 2.68 (+/-0.23) cm. Mean total DAP was 397.45 (+/-15.63) mu Gy m(2). Conclusion: CSNRB performed with Dyna-CT and the tested laser guidance system is feasible. 3D pre-puncture planning is easy and fast and the laser-guiding system ensures very accurate and intuitive puncture control.