الفهرس 
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Abstract
SUMMARY, CONCLUSION AND RECOMMENDATIONS
Summary
Injection therapies are becoming integral parts of a multidisciplinary approach in the treatment of low back pain, cervical pain and radiculopathy. Ultrasound guided injection has been extensively used because of its accuracy in therapeutic spinal injections. Additionally, the US guided injection has multiple advantages over other imaging modalities including: direct visualization of the target of interest, real-time needle guidance, visualization of the spread of local anaesthetics and thus minimal risk of complications, a potential for dose reduction of local therapeutics, shortening of procedure time and the lacking of exposure to ionizing radiation.
The aim of this clinical trial was to evaluate the clinical efficacy of the US-guided pararadicular steroids and local anaesthetic injections in relieving cervical and lumbar radicular pain.
The study was conducted on 30 patients of both sexes with cervical or lumbar radicular pain with a mean age 36.50 ±9.69 years. All patients included in our study were radiologically assessed using MRI.
Our patients underwent Ultrasound guided cervical or lumbar pararadicular injection of 4 ml mixture of non-particulate corticosteroid solution (dexamethasone 4 mg/ml) and local anaesthetic (bupivacaine 0.5%).
The patients were clinically evaluated pre and post procedure by the functional rating index and the visual analogue scale.
The results of the study were summarized in the following:
There was a statistically significant improvement in the scores of FRI and VAS following US guided pararadicular injection.
There was no statistically significant difference between patients with cervical and lumbar disc prolapse regarding the improvement in FRI or VAS scores following injection.
There was no statistically significant difference between different disc pathologies regarding the improvement in FRI scores following injection but there was a statistically significant difference between different disc pathologies regarding the improvement in VAS scores following injection.
There was a statistically significant positive correlation between age and post injection FRI scores, but there was no statistically significant correlation between age and post injection VAS scores.
There was no statistically significant correlation between pain duration and either post intervention FRI or VAS scores.
Conclusion:
US guided pararadicular injection can be considered one of the effective modalities in the treatment of cervical or lumbar radicular pain.
There was no effect of the site of disc pathology either cervical or lumbar on the response to US guided pararadicular injection.
The response to US guided pararadicular injection in cervical or lumbar radicular pain can be partially affected by the degree of disc pathology.
The response to US guided pararadicular injection in cervical or lumbar radicular pain can be partially affected by age being more effective in younger ages.
There was no effect of pain duration on the response to US guided pararadicular injection in cervical or lumbar radicular pain.
Recommendations
Confirmation and extension of these results in larger scale studies and for a longer duration.
Comparison between Ultrasound versus CT guided pararadicular injections in cervical or lumbar disc prolapse.
Comparison between Ultrasound versus Fluoroscopy guided pararadicular injections in cervical or lumbar disc prolapse.
Comparison between in-plane versus out-of-plane Ultrasound guided pararadicular injections in cervical or lumbar disc prolapse.
Comparison between Paramedian sagittal and paramedian sagittal oblique ultrasound guided pararadicular injections in cervical or lumbar disc prolapse.
Further researches should be directed towards studying the effect of ultrasound guided pararadicular injections on diffusion tensor imaging parameters and MRS biomarkers in cervical or lumbar disc prolapse.
Limitations
-Limitations of ultrasound guided injections include technical factors, patient factors, and operator factors.
-Technical factors include the acoustic shadow artifact produced by bone and a reduction in image resolution with increasing depth,shadowing by bone and decreased resolution may hinder the identification of injectate spread and intravascular injection in deep injections.
-Patient factors include abnormal anatomy, degenerative changes or body habitus (obesity).
-Operator factors include technical skill and experience.