Title: A novel ultrasound guided approach for lumbar periradicular injections with investigating the radicular artery nearby (IRAN) technique

Biography:

Helen Gharaei has completed her MD in the Mashhad University of Medical Science (1992) and postdoctoral studies in anesthesiology in Uremia University School of Medicine and has got her pain fellow degree from Tehran University of Medical Science from Iran (2012), and FIPP degree (Fellowship of Interventional Pain Practice) from Texas Tech University, USA (2013). She has specialized training in minimally invasive chronic pain procedures for medically challenging patients and practice in a private multidisciplinary clinic in Tehran, Iran. She has published many books and papers focusing on the safety of pain injection and has been serving as an editorial board in the reputed journal. She invited as a speaker in many international conferences from the beginning of her professional carries. She is an international trainer & researcher and known as a pioneer on ultrasound-guided spine injection, especially she is the inventor of the IRAN technique in spine injection. She has been teaching at multiple interventional pain management courses including cadaver workshops of ultrasound & fluoroscopy-guided pain injection locally and abroad. She is an education committee in interventional pain and spine center (IPSC) and founder of Son- Guide Pain Injection School of Iran. She constantly contributes to the growth of pain education worldwide.

Abstract

Objectives

The object of this study is to introduce a novel USG approach for lumbar periradicular injections by investigating radicular artery nearby (IRAN) technique and to assess the feasibility and preliminary means by fluoroscopy.

Study Design

The USG periradicular injection is performed under real time imaging. An axial scanning view is obtained through identifying the spinous processes, lamina, zygapophyseal joints and transverse processes.

Setting

The curve probe put transversally  and the needle site check in axial and sagittal view.

Methods

The IRAN technique was defined by sliding probe a little lower under the facet joint in sagittal plane to view the pulse of nearby radicular artery by Doppler or Pulse Echo. Then spinal needles are advanced with in-plane technique toward the artery until touch the nearby bone.

Results

Fluoroscopy examination confirms that the needle tip is correctly placed under the pedicle along the nerve root  and  lateral to the pars interarticularis with no intravascular injection.

Limitation

Although searching for small vessels is difficult in cadaver studies, the IRAN technique would be confirmed in the future on Cadaver section.

Conclusion

The IRAN technique introduce pulse of  artery (spinal ramus branch of the lumbar segmental artery (SA) or SA itself, not radicular artery) as a new sonoanatomic landmark for safe periradicular placement of the needle for extraforaminal injection.